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.