Physician Billing Audits in New York State

Physician billing is often the target of auditing companies that seeks to determine whether the physician billed patients too much money for their services. When a physician is audited, the auditing company will assess a small sample of what the physician has billed in an effort to look for places where they may have over-billed. After collecting and analyzing the sample, the auditing company will come up with a percentage of the billing that was too high.

Of course, the insurance company is going to assume that the percentage of over-billing happens regularly. The insurance company will likely send a demand letter requesting that the physician pays them back all of the money that they overbilled in years past. This can amount to hundreds of thousands of dollars, which can be signficant for the physician. The physician should consult with an experienced attorney that can help determine whether it is worth it to fight this claim with the insurance company. However, if the physician does fight an audit claim, the matter will be decided upon by an arbitrator and cannot be appealed. In addition, the physician may be subject to an investigation by the OPMC.

If you have received a demand letter regarding an audit from an insurance company, contact us today.

When a medical professional is accused of misconduct, it is essential that they retain strong legal representation. If you require a medical law attorney for your legal matters, call Paul E. Walker, an experienced New York City OPMC & OPD Lawyer. Please contact the Walker Medical Law firm to set up a free initial consultation.