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Last Updated on: 19th October 2023, 01:03 pm
Medicaid audits in New Jersey can be intimidating for healthcare providers. But with the right legal guidance, you can successfully navigate audits and avoid penalties. This article provides a helpful overview of Medicaid audits in New Jersey, potential penalties, and how experienced lawyers can assist you.
Depending on the circumstances, Medicaid audits can lead to:
Even unintentional billing errors can trigger substantial penalties under applicable laws like the federal False Claims Act and New Jersey False Claims Act.
Treble damages may be imposed if overpayments resulted from “false or fraudulent” claims. This means the provider must pay back triple the amount of the overpayment. Civil penalties up to $11,000 per claim can also be imposed.
In cases of intentional fraud, criminal prosecution is possible. This can lead to imprisonment, fines, and exclusion from Medicaid. Anti-kickback violations and other offenses can also bring criminal penalties.
With so much at stake, having an experienced New Jersey Medicaid audits lawyer on your side can make a critical difference. Here are some key benefits:
Not all lawyers have the skills and experience to address Medicaid audits effectively. When selecting legal counsel, providers should:
Reputable Medicaid audits attorneys have helped many providers reduce penalties and avoid criminal prosecution. But every case is different. Be sure to ask prospective lawyers about their specific experience and credentials.
To defend your interests, it helps to understand how the Medicaid audit and appeals process works in New Jersey:
This summarizes the key stages in the Medicaid audit appeals process. There are strict deadlines and many complexities at each stage. Having an attorney experienced with these rules by your side can prove invaluable.
Healthcare attorneys serve as trusted advisors and advocates throughout the Medicaid audit process. Here are some of the ways they can help:
Lawyers will scrutinize any audit notices and record requests you receive. They will look for defects that could make the audit invalid or limited in scope. The lawyer can also discuss strategies to get clarification from auditors.
Experienced audits attorneys know what types of documentation auditors want to see. They will work with you to gather relevant medical and billing records. The lawyer will withhold any privileged materials. They may also negotiate with auditors to limit the scope of records requests.
Your lawyer will thoroughly review the records before production to identify any compliance problems or gaps in documentation. The attorney can offer remedial steps and help get your billing practices in order before the audit concludes.
When you receive preliminary findings, your lawyer will scrutinize them for unfounded assertions. They will point out flaws in auditors’ reasoning and evidence. The attorney submits written disputes backed by documentation and legal arguments.
If the auditors impose penalties or recoupment, your attorney will advise on the merits of appeals. The lawyer handles each stage of the appeals process, meeting deadlines, gathering evidence, and forcefully presenting your arguments.
In many cases, attorneys can negotiate settlements with regulators to reduce penalties and overpayment demands. They work cooperatively with the government when possible to achieve fair outcomes.
If allegations escalate to fraud investigations, your attorney protects your rights and works to prevent criminal charges. Experienced lawyers engage prosecutors to dissuade them from pursuing indictments.
For large providers, Medicaid audits often lead to lawsuits and multi-agency investigations. Lawyers coordinate across these proceedings to present consistent defenses. They bring efficiency and cohesion to the defense strategy.
Having an attorney guide you through the audit and appeal process can vastly improve your chances of a favorable outcome. Their expertise allows you to focus on serving patients rather than getting lost in regulatory complexities.
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