When a medical professional finds out that they are being audited, it can be a burdensome time in their life. This may happen if they are accused of overbilling their patients. In these situations, it is important to retain the services of a New York medical defense attorney who can guide you through the process and defend you against an unwarranted audit.
What is the Audit Process?
Medical professionals are usually audited regularly by the Health Maintenance Organization (HMO) as well as the government in order to recover any money that has been paid. In most cases, insurers hire a company to do this for them. This can be unfair, as auditors only glance at a small percentage of a physician’s billing in an attempt to find certain areas where they overbilled patients for their services. They may then assume that this applies to all of their billing over a period of time. When this happens, the insurer will most likely send a demand letter to the physician, stating that they owe a large sum of money. Unfair audits can place a medical professional’s entire character and career into question, which is why they should contact an attorney for assistance during this time.
Can I Settle a Claim?
When facing these situations, the best course of action is to settle for the lowest number possible. The process of settling a claim begins by speaking with the insurer and appointing your own auditors. The job of these individuals is to audit the insurance company’s auditors. In order to obtain a positive settlement, there are three main qualifications that must be met. This can include proving that either the audit was not done at random, was unreliable, or that the allegations against you were unfounded. If possible, it can be beneficial to be able to refer to specific examples of times where you underbilled patients that the auditors did not take notice of.
Can I Fight a Claim?
Medical professionals are not always able to fight a claim. However, this does not mean it is impossible. In order to do so, individuals must have an attorney thoroughly examine their contract with the insurer. Sometimes, these contracts contain an arbitration clause that states how any dispute must be determined by an arbitrator first. It is important to note that if this is done, the medical professional will not be able to appeal the decision if they believe it is unfair. In addition to this, it can result in an investigation and possible hearing being opened up by the Office of Professional Medical Conduct. When this happens, it can jeopardize their medical license.
Contact our Firm
When a medical professional is accused of misconduct, they must 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.