Why would a physician be audited?

In the medical field, professionals work to ensure that patients are treated with the proper care. This care is done with experience from intelligent individuals. Since they are providing quality care to patients, they expect to be compensated in return for this. When patients are billed, it may be an amount they expect. However, sometimes bills may seem out of the ordinary. If a physician is overcharging patients, they may be sought for this offense. A physician’s bills for their patients can be looked into. If an HMO decides to do an audit of the physician, they may find that the medical professional is overcharging their patients. This can take away from the patient’s care. It can compromise the doctor’s standards and their ethics as someone who is supposed to be taking care of the well-being of others. When these situations arise, they should be investigated to come to a resolution.

For these instances, HMOs and the government may go through routine audits to recover money that has been paid to physicians for health care. The insurer may ask for money that should be recovered because it was determined to be over-billed. This can be a difficult situation for physicians to face because their finances can then be called into question.

How can a medical professional defend themselves?

When physicians are blamed for overcharging on their bills, they should seek an auditor themselves to aid with their defense. By obtaining their own auditor, they can have their bills justified and have them go through their insurer’s audits. With this extra work, they may be able to retain the money for their services that was paid to them.

The physician being audited will have to prove that the audit was not reliable and that the allegations are not supported after they have someone conduct an audit of themselves. They may even have instances where underpayments were made and that can be used as well to support their case even further. This information can all be used to drive down the percentage that the insurer claims is owed back to them. If the doctor believes that the claims are false, they may have the opportunity to prove so with their own audit. This can help support them and show that the insurer’s claims are not backed up with evidence. An audit can reveal costs that the doctor should be aware of.

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.