New Jersey medicaid audits lawyers

By Spodek Law Group | August 30, 2020

Being informed that you will undergo a Medicaid audit is typically very stressful for the average healthcare provider. However, such an audit is a normal, routine occurrence in the operations of a medical facility and does not necessarily indicate that your practice has aroused suspicion.

Your first reaction to receiving notification that you will be undergoing a legal audit is to find experienced legal counsel. An audit requires you to fulfill certain responsibilities that can be time consuming and complicated. It’s best to relegate these duties to an experienced professional and focus on your main job task.

If you meet all of your responsibilities in submitting the appropriate forms and documentation for the audit, you should have no trouble. Legal counsel is of vital importance in being confident that you’ve done everything you need to do to put the audit behind you.

What is the purpose of Medicaid audits?

A Medicaid audit is meant to look out for any fraudulent conduct by healthcare providers when filing claims. During an audit, you will need to show clearly that you have not overcharged the Medicaid program.

One reason why handling audits can be a particularly complicated business is because of all the different contractors out there who are in charge of carrying out these audits. Different contractors often go about the process differently so that a healthcare provider who has dealt with a particular contractor cannot assume the same experience if a future audit comes from a different contractor.

When a contractor handles an audit, they will be looking to recover funds that were unfairly charged to Medicaid. The contractor may have a financial incentive to do so. The best way to cope with audits is to already be doing interior audits organized by your own personnel on a regular basis. If you perform regular interior audits yourself, you’ll be highly familiar with your Medicaid practices and you’ll be more confident that your organization is not guilty of any violations.

The following are some important things you need to know about dealing with a Medicaid procedures at your New Jersey healthcare practice:

  • There are numerous audit contractors you could possibly have to deal with- Various audit contractors initiate audits. Audits can be initiated by either government programs or private payor contractors. Private payor contractors do audits on behalf of commercial insurance providers. Some Medicaid audit contractors out there include Medicaid integrity Contractors, Recovery Audit Contractors, Comprehensive Error Rate Testing programs, and Quality Improvement Organizations.
  • You’ll need to compile a list of and details on all the claims you’ve submitted- When audits take place, your record keeping practices become more important than ever. Hopefully, you’ve kept careful records so that you can easy put together a list of the clams you’ve submitted. This list should include details on the amount Medicaid has paid out for these claims.
  • Due dates are important- Procrastinating about a Medicaid audit can cause you to incur certain penalties. You need to respond immediately and make note of any due dates that are listed as dates before which you need to submit certain records. Remember that any due dates provided don’t specify the date by which a document has to be mailed. A due dates specifies the date before which the American Health Care Association need to have received the documents
  • You’ll probably need to fill out and submit the Medicaid Provider Questionnaire- A Medicaid Provider Questionnaire will typically need to be filled out by all healthcare providers who undergo an audit. It’s important that you answer every question on this questionnaire and that you include any documents that are required when you send it in. You should discuss the questionnaire and your responses with your attorney before you send it in.

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