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Medicaid billing and reimbursement is governed by thousands of regulations meant to make sure that healthcare providers such as hospitals, physicians and even nursing facilities do not commit Medicaid fraud such overpayments. Perhaps because of this high number of regulatory requirements, thousands of medical practices and facilities get audited each year by Medicaid for suspected Medicaid fraud. If the audit proves that fraud or series of frauds were committed, consequences can be quite grave. In New Jersey, such Medicaid frauds are punishable by fines as high as $10,000 and up to 3 years of jail time. It is, therefore, not for no reason that getting a notification that your practice is going to be audited for suspected Medicaid fraud is one of the scariest news a doctor can ever receive. Usually, it is very hard to satisfactorily resolve cases of alleged Medicaid fraud without the help of lawyer with considerable experience in issues of Medicaid audits and fraud. Having an experienced NJ medicaid audit lawyer guide you during the audit process can have a huge difference on the outcome of the case. Here is a look at some of the things a Medicaid audit lawyer can do for you to help you have a successful audit.

Determining reason for the audit

The notification letter for audit usually contains reason(s) for carrying out the audit on your practice and the scope of that audit. Most of these notification letters are usually straightforward. However, there are others that may be worded in a manner that does not clearly bring out the reason or reasons for the audit. An audit lawyer will help in clarifying these reasons and explain to you the specific regulatory requirement you are alleged to have ignored. This is important as it helps you make the necessary changes to avoid a similar audit in future.

Determining the kind of documents to present to the auditors

George FernandezGeorge Fernandez
14:16 30 Apr 24
Excellent 10 out of 10, Helped resolve my case. Jeremy explained everything and made everything easy to understand.
21:33 24 Apr 24
If you are looking for a lawyer that listens, is aggressive where needed, and holds his word above all else, Todd is the best pick. I had hired multiple attorneys prior to hiring the Spodek Group for a white collar case. The first thing that stood out to me was the cost, as anyone going through the process and dealing with the system, money was tight at that time - especially after hiring and firing multiple lawyers. The cost was not as high as others which was definitely a plus. Todd's intake process was also unlike other attorneys. He took the time to actually listen. He cared. He was trying to put himself in my shoes while I was explaining the situation to him and he really took the time to understand the whole situation. Other lawyers will give you 15 mins and send you a retainer agreement. Not Todd, I think he spent almost two hours with me as I was explaining everything.Not only was he great during the onboarding process, he was supportive and very informative through the entire plea process and eventually sentencing. After hiring him, I asked if I should hire a prison consultant, he told me to save my money as he would do everything they would. He was right and held up to his word. Later on I would hear from others that went with the prison consultants that they were a waste of money - I am glad I listened to Todd!When it came time for sentencing, two days prior to sentencing, the prosecutor tried increasing my proposed prison time by almost double - apparently a normal move. Todd and his team worked with me non-stop through the weekend prior to sentencing to ensure that I was not given additional prison time. Again, he took the time to listen and came up with a strategy to explain the case with great detail.Unfortunately, I did plead guilty as that was my best option. Todd and his whole team wrote up nearly 300 pages of a summary of what happened and why I should not be given prison time. If I breakdown the amount I spent with Todd versus the amount of work that I saw being done, I am shocked I was not charged four times as much. The other benefit was, a lot of criminal defense lawyers were just a single attorney with a paralegal or two. Todd had a team of people that I dealt with (5-7 people that I interacted with), but he was ALWAYS accessible. It would never take him more than an hour to reply unless he was in court.I was sentenced to prison and I was emotionally distraught. Todd and his team did whatever they could even after sentencing to make sure I was alright. He personally stayed in touch with my family to ensure I was doing alright and offered support to them. Most lawyers would consider the job complete at sentencing, not Todd.After prison, Todd still spent time with me to make sure I was on the right track and avoiding any potential risks in the future. He has also been giving advice on how to navigate probation etc and has not been looking at the clock for billing.Although I wish I had never been arrested in the first place, I am glad I had Todd and his team in my corner. Without them I likely would have had to spend a lot more time in prison than I did.Thank you, Todd, and the entire Spodek Law team, for helping turn what was a nightmare into a manageable situation!
Yelva Saint-PreuxYelva Saint-Preux
19:26 19 Apr 24
I am immensely grateful to the entire team at Spodek Law Group for their unwavering dedication and exceptional expertise throughout my case. From our initial consultation to the final resolution, their professionalism and tireless advocacy made all the difference. Their strategic approach and attention to detail instilled confidence in me every step of the way.Thanks to their hard work and commitment, we achieved a truly favorable outcome that exceeded my expectations. Not only did they navigate the complexities of my case with precision, but they also provided invaluable support and guidance during what was undoubtedly a challenging time. I cannot recommend Spodek Law Group highly enough, especially attorneys Todd Spodek and Claire Banks; they are beacons of excellence in the legal profession.YSP.
Katherine SunKatherine Sun
18:08 18 Apr 24
my lawyer is Alex Zhik. Efficient, patient and professional
Nun yaNun ya
17:48 18 Apr 24
Todd, Ralph and Alex are amazing. Helped my husband get from a double digit number with multiple charges to a single digit, by the time I blink he will be out. They very professional and help with all your needs. They dealt with my anxiety and worry very well and they understand that your family member needs to get home as soon as possible.
Keisha ParrisKeisha Parris
20:45 15 Mar 24
Believe every single review here about Alex Z!! From our initial consultation, it was evident that Alex possessed a profound understanding of criminal law and a fierce dedication to his clients rights. Throughout the entirety of my case, Alex exhibited unparalleled professionalism and unwavering commitment. What sets Alex apart is not only his legal expertise but also his genuine compassion for his clients. He took the time to thoroughly explain my case, alleviating any concerns I had along the way. His exact words were “I’m not worried about it”. His unwavering support and guidance were invaluable throughout the entire process. I am immensely grateful for Alex's exceptional legal representation and wholeheartedly recommend his services to anyone in need of a skilled criminal defense attorney. Alex Z is not just a lawyer; he is a beacon of hope for those navigating the complexities of the legal system. If you find yourself in need of a dedicated and competent legal advocate, look no further than Alex Z.
Taïko BeautyTaïko Beauty
16:26 15 Mar 24
I don’t know where to start, I can write a novel about this firm, but one thing I will say is that having my best interest was their main priority since the beginning of my case which was back in Winter 2019. Miss Claire Banks, one of the best Attorneys in the firm represented me very well and was very professional, respectful, and truthful. Not once did she leave me in the dark, in fact she presented all options and routes that could possibly be considered for my case and she reinsured me that no matter what I decided to do, her and the team will have my back and that’s exactly what happened. Not only will I be liberated from this case, also, I will enjoy my freedom and continue to be a mother to my first born son and will have no restrictions with accomplishing my goals in life. Now that’s what I call victory!! I thank the Lord, My mother, Claire, and the Spodek team for standing by me and fighting with me. Words can’t describe how grateful I am to have the opportunity to work with this team. I’m very satisfied, very pleased with their performance, their hard work, and their diligence.Thank you team!
K MarK Mar
01:37 25 Jan 24
I recently had Spodek Law Group represent me for a legal matter in NYC and I am thoroughly impressed with their services.Alex Zhik secured the best possible outcome for my case.It was a seamless journey from the initial consultation to the resolution of my legal matter. From the moment I spoke to Todd about my case, his enthusiasm to help was evident, setting a positive tone for the entire experience. The efficiency and professionalism displayed by the team is commendable.A particularly noteworthy aspect of their service is their user-friendly portal to upload your documents/evidence. This not only simplified the process, but showcases their commitment to streamline the client experience.Lastly, in an industry where legal fees can often be a concern, I found their pricing to be very reasonable, making needing legal assistance feel accessible and stress-free.I am grateful for their support and wouldn't hesitate to turn to them again in the future.

Medicaid auditors usually request specific documents for use in the audit process. However, sometimes doctors are often at a loss on whether to present the exact requested documents or give them a few additional ones that might support their case. Depending on the situation, presenting the auditors with extra documents might or might not be of help. A Medicaid lawyer will carefully assess your situation and determine if presenting such additional documents is necessary. If there such need, the lawyers will help you in choosing the specific documents that will best explain your medical decisions. Preparing the documents with the help of an audit lawyer will also help you avoid taking actions that make you appear guilty such as making changes to the documents.

Filling in the questionnaires

When Medicaid auditors come to audit your practice they seek to identify specific suspected violations of regulatory requirements that you may have committed. Usually, this involves checking out for any billing errors. Apart from asking for documents, they also require you to fill in questionnaires for use in the audit process. Having a NJ Medicaid audit lawyer will help you fill in the questionnaires in an accurate and appropriate manner that does not raise any further suspicions.

Finding coding consultants

During the audit process, you may need coding consultants and other experienced professionals to help you go through the experience successfully. With their experience and knowledge of experts in the field, Medicaid audit lawyers will help in finding for you the best coding consultants. Using your Medicaid audit lawyers to find coding consultants for you also has a major legal advantage. If you decide to hire your own consultants, auditors can have access to their findings and use them as evidence against you. However, if it is your lawyer who hired the consultants, there are ways in which the auditors can be denied access to their findings. This is very important as findings from coding consultants can make a huge difference in your case.

Planning your defense

Medicaid audit lawyers with considerable experience usually know all the tricks used by auditors in cases involving doctors suspected of Medicaid fraud. Through their experience, they can foresee some of the arguments the auditors are likely to use in the case and use those likely arguments to plan your defense. This helps you in getting the best outcome possible.

Determining the best cause of action if you are found guilty

Hiring a Medicaid audit lawyer increases your chances of having a successful audit that leaves your practice intact. However, sometimes auditors find even honest doctors to have committed Medicaid fraud. If this happens, your lawyer will carefully analyze all the options available and choose one that will give you the best outcome for your situation. For example, if the Medicaid audit lawyer thinks that there are grounds for appeal, they may decide to take that option. Sometimes, they may help in reducing your fine and even avoid criminal prosecution.

Appealing a negative audit decision

A normal audit is usually stressful, time consuming and very stressful. An appeal is even more stressful and complicated. It involves a lot of research and paperwork with very tight deadlines to meet. The extensive research and documentation needed can take up so much of your time that it becomes difficult to effectively attend to your patients. Then there are also numerous procedural and legal arguments that can only be made effectively by a lawyer experienced in cases involving Medicaid fraud. Hiring an experienced audit lawyer will, therefore, not only make the whole process a lot easier but also improve your chances of having a successful appeal that allows you to continue enjoying all your medical privileges. Even if you decide to handle the appeal on your own, it is still important to seek the help of a Medicaid audit lawyer. They will help you in drafting templates and briefs for use in the appeal process.

Avoiding future audits

Whether the auditors find you to have committed fraud or not, Medicaid audits are still frightful experiences. The fines, lost time and high cost involved in having one is usually very stressful to many doctors. After experiencing one, no doctor would want to have another one. Hiring a Medicaid audit lawyer will help you achieve just that. They will advise you on some of the issues that may result in future legal problems and the changes you need to make to avoid future audits and other legal problems. In addition, the coding consultants hired by your audit lawyer will let you know the coding patterns that resulted in the audit being done and the kind of changes you need to make to your coding and charting methods to avoid a repeat audit.

Running a modern medical practice is more complicated than it has ever been. There are thousands of laws and regulations that you have to comply with. Whether it is out of ignorance or accident, it is very easy to raise suspicions of Medicaid agents and have your practice audited for suspected fraud or violations of one or more of these regulations. As shown above, if you receive a notification to audit your practice the first step you should take is to hire an experienced Medicaid audit lawyer. That will go a long way in ensuring that you get the best possible outcome for your practice.

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