Medicaid Audit Defense Attorneys

Large Ring Binders at a Medical Facility

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.

The Medicaid Audit Defense Lawyers at Chapman Law Group Are the Advocates You Need

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 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.

We represent providers and practices nationally — from Chicago to Los Angeles, and from Miami to Detroit — 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, and Safeguard (PSC) audits.

The Medicaid audit attorneys at Chapman Law Group have been helping health care providers for 35 years. We practice across Michigan, including the Detroit, Ann Arbor, Grand Rapids, Dearborn and Troy areas; in Florida (Miami, Tampa, Jacksonville, West Palm Beach, Orlando and other regions), and nationally in regions including Los Angeles and Southern CaliforniaChicago, Pittsburgh, and Washington, D.C.

Our extensive experience in key areas of regulatory compliance in healthcare include:

We represent licensed medical professionals across the U.S., including:

Our offices are in Detroit (where we serve
Dearborn, Troy, Ann Arbor and Grand Rapids, and the rest of Michigan); 
Miami and Sarasota,
(for Jacksonville, Tampa, Orlando, West Palm Beach, and all of
Los Angeles/Southern California; and Chicago

With lawyers dedicated to helping providers defend their claims during audits, recovery action and appeals, you are in strong hands. Contact us today for a consultation.


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