As mentioned, home health agencies are increasingly undergoing audits and their claims are being heavily scrutinized. We assist home health agencies with all stages of the Medicare and Medicaid audit process
Our team of attorneys includes a former health care fraud prosecutor who is exceptionally knowledgeable and experienced in fraud detection strategies, audit procedures, appeals process, and administrative, civil and criminal proceedings.
Audits are conducted for two reasons: 1) to spot check claims samples, including high-risk claims, and 2) investigate claims where there is a suspicion of fraud. We help agencies respond to records requests in a manner that demonstrates that claims meet all required conditions of payment.
If recoupment is sought, we assist agencies with overpayment demand appeals and/or negotiate a more favorable settlement/repayment schedule.
The Medicare appeals process is complicated with five different stages, multiple parties, multiple filing deadlines and evidentiary deadlines. Therefore, we strongly recommend that agencies retain attorneys to respond to auditor’s requests and appeal overpayment demands.
Overpayment action can lead to recoupment of the overpayment (ten of hundreds of dollars), plus fines, penalties, interest, payment delay on future claims and even of loss of licensure.