What Happens if I Am Audited for Medical Billing?

As a physician, you should accept that a government agency, such as the Health Maintenance Organization (HMO), Medicare, or Medicaid, is going to regularly audit your medical billing practices. However, you should not accept any wrongful accusations of improper billing practices. Read on to discover what happens when you get audited for medical billing and how one of the seasoned HMO/Medicare/Medicaid audit protection lawyers at Walker Medical Law can help you defend against any billing fraud accusations.

What happens when I am audited for medical billing?

First of all, the HMO, Medicare, or Medicaid may audit you to identify, monitor, and correct problem spots in your billing practices. Essentially, the government agency is working to ensure that you are not overcharging your patients, and it believes that this inhibits your patients’ healthcare needs from being met.

So when you are audited for medical billing, you may expect the government agency to hire a third-party company to do the auditing. This auditing company may investigate a small sample of your recent billings and make a sweeping conclusion as to whether overbilling practices exist. Ultimately, the HMO, Medicare, or Medicaid may offer the auditing company a percentage of any of the overbilled money that is recovered. This is why auditors are notorious for doing everything in their power to identify instances of overbilling, even if their generalizations are not exactly accurate.

What happens if I am wrongfully accused of billing fraud?

To reiterate, an auditing company may only extract a small sample of your recent medical billings to fulfill the requirements of a proper audit. However, this small sample may not be an accurate representation of the entirety of your billing practices.

As an example, say that it audits 25 of your recent medical charts and finds that you overbilled your patients by 30 percent. In numbers, it may claim that you billed $5,000 instead of $3,500. Well, from here, it may assume that you have been doing this for, say, six years; so it claims that you billed an overall $400,000 when you should have billed $280,000. Ultimately, it may demand that you pay back a total of $120,000 in damages.

Practices such as these are what make wrongful accusations of billing fraud all the more common. So if you have been made the subject of this terrible claim, then you must decide to either settle the claim or fight it off. Your choice may be dependent on the specific circumstances surrounding your case.

In the end, though, you must not jeopardize your chance to successfully settle or fight back on a billing fraud claim. So please retain the services of one of the competent HMO/Medicare/Medicaid audit protection lawyers from Walker Medical Law as soon as you can.