Last Updated on: 19th October 2023, 01:36 pm

The Importance of Legal Representation in Medicaid Audits

In today’s complex world of healthcare, government-funded programs such as Medicaid are under more scrutiny than ever. With budget deficits looming for the federal government and funding being tighter than ever, government officials are determined to make sure the money associated with these programs is used in the proper manner. Because of these increasing regulations and concerns, many healthcare providers have found themselves the subject of Medicaid audits by government investigators.

Factors Leading to an Audit

Unfortunately, Medicaid providers deal with many factors that may ultimately result in an audit being conducted regarding their activities. Some of the most common factors that may result in an audit include:

• Falsifying records to justify unnecessary medical procedures
• Billing for services that were never provided
• Filing claims for fake services
• Illegal kickbacks
• Misrepresentation of procedures that were performed

Because investigators are always on the lookout for potential fraud, many healthcare providers fail to realize just how much they are at risk of being audited and subsequently accused of Medicaid fraud. Due to the complexity of Medicaid rules and regulations, many providers make honest mistakes when it comes to coding and billing for procedures they have performed. As a result, investigators will often make up their minds early on that fraud has been committed, when in fact nothing but honest mistakes by honest people have occurred. It is in these situations that you need strong legal representation, such as that which is delivered by Potashnik and Associates. Having many years of experience handling these cases, we know how government investigators think. Because of this, we can immediately go to work protecting our clients from unfounded accusations and threats of fines and imprisonment. When you retain Potashnik and Associates as your legal counsel, you can be assured of getting the best legal protection possible.

How Are Audits Determined?

One of the most confusing aspects of Medicaid audits is understanding the factors investigators use to determine which practices get audited and which ones do not. In our many years of handling these cases, it has always been frustrating to find out that those who are being audited often are not even aware of what is happening. By using these practices, the government is essentially taking away the rights of those they are accusing of wrongdoing.

In many cases, auditing agents will subpoena bank records, review billing information, and speak with employees or patients. In extreme cases, they may even go undercover to visit your office in an attempt to get the provider to conduct illegal activities on them. If all else fails, federal agents may choose to raid the office and seize files, computers, and other information. If any of this happens to you, don’t attempt to go it alone. Contact us here at Potashnik and Associates as soon as possible, so that we can work with you and ensure investigators are following the rules when doing their job.

In most cases, we have found that investigators have already determined guilt prior to conducting a raid or using other investigative methods. However, we still go by the guiding principle that a person is innocent until proven guilty. Therefore, rather than stand by and let investigators do as they please, we instead force them to follow whatever rules are necessary prior to leveling any charges against you or your staff.

To Do or Not to Do?

When you find yourself the recipient of a Medicaid audit, there are many things you should and should not do in order to protect your rights and your reputation. For starters, you should contact us here at Potashnik and Associates immediately. By letting investigators know from the start you have legal representation that has considerable experience in these matters, the investigators will in many cases back off briefly for fear of violating the victim’s constitutional rights.

In addition to retaining us as your legal counsel, there are several things you should never do while under investigation. These can include:

• Discussing the case with anyone except your attorney
• Instructing patients or staff to lie to investigators
• Altering any documents associated with the audit
• Allowing anyone who does not have a warrant to review or confiscate records

When being the subject of a Medicaid audit, it’s always better to begin your defense as soon as possible. In almost any case, the government has a head start on you, and has spent considerable time and money in an attempt to find you guilty. Rather than sit back and let them dictate the outcome of your case, let us here at Potashnik and Associates launch our own offensive. We too can gather files and records to examine, and will often do so in order to have expert witnesses examine them and reach their own conclusions. Here at Potashnik and Associates, we believe a good offense is the key to winning these cases, and will do everything possible to make sure that’s what happens.

Protect Yourself from Medicaid Fraud Audits with Spodek Law Group

Scrutiny on Government-Funded Healthcare Programs

In today’s labyrinth of healthcare complexities, government-funded programs such as Medicaid are being closely monitored. With the impending budget deficits and tightening funds, government officials are striving to ensure the proper allocation of resources in these programs. This has led to an increasing number of healthcare providers finding themselves the subject of Medicaid fraud audits by government investigators. If you are caught in this situation, unsure of how to proceed, the experienced legal team at Spodek Law Group is here to guide you.

Who Conducts Audits?

A multitude of agencies may be involved in the audit of a healthcare provider, suspecting fraud. Among these are the FBI, U.S. Attorney General’s Office, Department of Health and Human Services, Office of the Inspector General, and many others. Federal and state laws enforce that doctors and healthcare providers comply with record reviews by investigators from these agencies. Despite these obligations, there are several avenues available to protect privacy and confidentiality during these audits. Spodek Law Group is well-versed in the process and will work tirelessly to protect your rights.

Factors Leading to an Audit

Various factors may result in a Medicaid provider audit, including:

• Falsifying records to justify unnecessary medical procedures
• Billing for services that were never provided
• Filing claims for fake services
• Illegal kickbacks
• Misrepresentation of procedures that were performed

Due to the complexity of Medicaid rules and regulations, numerous providers unknowingly make honest mistakes when coding and billing for procedures. Government investigators may hastily conclude fraud when the actual situation is an honest error. In these instances, the support of strong legal representation found in Spodek Law Group is indispensable. Our team’s experience and understanding of government investigators’ thought processes allow us to immediately protect our clients from unfounded accusations and threats of fines or imprisonment.

How Are Audits Determined?

Understanding the factors investigators use to determine which practices are audited can be confusing. Many practices being audited are often unaware they are being scrutinized. Auditing agents may subpoena bank records, review billing information, speak with employees or patients, or even use undercover tactics to gather information. Federal agents may choose to raid offices and seize files, computers, and other information. If any of this occurs, it is crucial to contact Spodek Law Group as soon as possible. Our team will ensure investigators follow proper rules when conducting their job to protect your rights.

What to Do and What Not to Do

When faced with a Medicaid audit, immediately seeking legal representation from Spodek Law Group is imperative. By alerting investigators at the outset of your experienced legal representation, the investigators may take caution to avoid violating constitutional rights. Along with obtaining legal counsel, the following actions should be avoided during the investigation:

• Discussing the case with anyone except your attorney
• Instructing patients or staff to lie to investigators
• Altering any documents associated with the audit
• Allowing anyone without a warrant to review or confiscate records

A proactive defense is critical in Medicaid fraud cases. By partnering with Spodek Law Group, we can gather and examine files, enlisting expert witnesses to reach their own conclusions. Our firm’s philosophy is to fight tenaciously for our clients – a strong offense is the key to winning these cases.

Contact Spodek Law Group Today

The moment your practice faces a Medicaid fraud audit, time is of the essence. Government investigators are determined to prove you guilty and proceed to their next case. Arm yourself with the expert legal team at Spodek Law Group. We will examine records, consult with employees and patients, and take every necessary action to protect your personal and professional life during this difficult time. Don’t face these complex challenges alone – trust Spodek Law Group to stand by your side, offering the best legal protection possible.