What Can a Physician Expect in a Medicare Billing Audit in New York?

I represent physicians who are being accused of overbilling Medicare or other HMO institutions and this happens quite frequently and can be very dangerous. I did one about five or six months ago where the claim was the physician had billed the procedures he was doing incorrectly and the HMO wanted $51,000 back from him. I took a look at this and talked to the doctor. I then contacted the HMO and I had a long conversation with them about how they were going about this, what they thought he did wrong, and I looked at his records. I actually convinced them that they didn’t have a case against him. We’re not always that lucky, but sometimes we are and in that case the matter was dropped.

I’m in the midst of another one with an audit with Medicare and we had to submit the documents involving numerous patients, almost 20. We’ve sent that to Medicare. I really think that we’re going to do alright on this. I actually don’t know the answer completely. You have to go over the records carefully, look at the Medicare rules, and make sure that the doctor’s records match the requirements of Medicare or they will disallow the payment and make the doctor repay it. I don’t think that’s going to happen here, but it’s a thing that you have to be aware of. Be very careful when you’re dealing with Medicare because they look after their money pretty carefully and they can be aggressive when they’re doing this kind of work.

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