Medicaid Audit Defense Attorneys

Large Ring Binders of medicaid audit defense laws that Chapman Law Group health care fraud defense attorneys reference.

The Medicaid Audit Defense Lawyers at Chapman Law Group Are the Advocates Your Health Care Practice Needs

How are Medicaid Audits Started and Who Conducts Them?

In 2005, Congress enacted the Deficit Reduction Act of 2005which led to the creation of the Medicaid Integrity Program (“MIP”). Its focus and goal are to identify improper payments and overpayment of claims submitted to Medicaid. The MIP employs the use of Medicaid Integrity Contractors (“MIC”) to carry out auditing of provider billing records for inappropriate claims and overpayment.

What Happens in the Medicaid Audit Process?

Doctor filling out an audit form.Usually, a provider will receive notice of an audit by mail. The audit itself may take place at the site of the provider’s practice or remotely. During the audit, MICs have no limitations on patient medical records requests and may review claims submitted back to five years prior to the initiation of the audit.

At the end of the Medicaid audit, the MIC will send a detailed report to the provider indicating which, if any, claims submitted to Medicaid were questionable, inappropriate, duplicated or other. The provider has the opportunity to respond to the letter offering explanations, agreement or disagreement with each of the claims at issue within 30 days of receipt.

What Happens After the Medicaid Audit?

If the audit report contains any findings of inappropriate claims, MIP refers the findings to the state in which the provider resides. It is important to remember that the money Medicaid believes to be owed is paid by the state, which then initiates an action against the provider for reimbursement.

In addition to monetary consequences, Medicaid may take a variety of adverse actions against a provider such as:

These consequences can have serious civil and/or criminal ramifications for providers. While an audit may not seem serious at first, the results of the finding may have a lasting detrimental impact on a provider’s ability to continue to participate in Medicare and Medicaid in addition to potential criminal liability.

For Medicaid Audit Lawyers Who Have a National Reputation for Quality, Turn to Chapman Law Group

A Medicaid audit is no minor issue. Your rights are affected from initiation and beyond completion. The consequences of the audit report may be very serious, and it is important to have experienced legal counsel by your side.

We at Chapman Law Group understand that with a Medicaid audit, your livelihood may be at stake. We will fight to protect it, and we will work with you in making sure your healthcare practice is in compliance.

Our Medicare audit attorneys represent providers and practices nationally during Medicare audits, Medicaid audits, and third-party payor audits. Our team of Medicare and Medicaid audit attorneys has extensive experience in Medicare audits, including ZPICRAC, MAC, Safeguard (PSC), and Comprehensive Error Rate Testing (CERT) audits. 

At Chapman Law Group, our health care audit defense lawyers work out of four national locations:

    • Detroit, serving healthcare practitioners in the Metro Detroit area (Wayne/Macomb/Oakland counties, Dearborn, Livonia, Troy, Ann Arbor, etc.), Lansing, Kalamazoo, Flint, Grand Rapids, and all of the state of Michigan; and
    • Miami and Sarasota, Florida, where we represent physicians and healthcare providers practicing in West Palm Beach, Tampa, Gainesville, Orlando, Jacksonville, and throughout Florida; and
    • Los Angeles/Southern California, for health care providers in Santa Monica, Huntington Beach, San Bernardino, Pasadena, Anaheim, Long Beach, Newport Beach, Irvine, the San Fernando Valley, and the entire state of California.

Your healthcare practice is in strong hands with our health care audit lawyers, who are dedicated to helping you defend claims during audits, recovery action and appeals. Contact us today for a consultation.

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