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. Unfortunately, even though many of the healthcare providers have done nothing wrong, many find themselves under investigation for possible medicaid fraud. If you find yourself in this situation and don’t know where to turn next, let us here at the law firm of Spodek Law Group assist you with this pressing legal matter.
Who Conducts Audits?
If a healthcare provider is being audited due to suspicion of fraud, numerous agencies may be involved in the investigation. 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. Due to federal and state laws based on contractual provisions, doctors and other healthcare providers are subject to having their records reviewed by investigators from these agencies at any given moment. In addition, any provider who has entered into a contractual agreement to provide services to Medicaid patients is obligated to let the government review their records. However, despite these obligations, there are still many avenues one can take if they object to their records being confiscated and reviewed. That’s why you need the services of Spodek Law Group, since we are very familiar with the process and will work to ensure your rights to privacy and confidentiality are protected during any audits that may be conducted.
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
–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 Spodek Law Group. 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 Spodek Law Group 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 Spodek Law Group 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 Spodek Law Group 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 Spodek Law Group 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 Spodek Law, we believe a good offense is the key to winning these cases, and will do everything possible to make sure that’s what happens.
Contact Us Soon
If you find yourself and your practice being audited for Medicaid fraud, there is no time to waste. Investigators are determined to find you guilty, send you to prison, and get on to the next case. Fortunately, when you have us as your legal team, we won’t let that happen. Just like the government investigators, we will also examine records, speak with employees and patients, and do numerous other things on your behalf to keep your personal and professional life together during this ordeal.
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