Audits by government benefit programs such as Medicare and Medicaid are common for providers and often involve complex billing issues as well as a thorough knowledge of the administrative process. Lubell Rosen Attorneys protect health care providers from the inception of an audit to the conclusion and appeals. Each of the agencies have their own rules and requirements in responding to and challenging the outcomes of audits.
Medicare Audits – Medicare Audits involve request for records and responses to multiple entities including Medicare contractors as well as the Centers for Medicare and Medicaid Services (CMS). The outcomes of those audits often involve restrictions on billing (prepayment review), overpayments and recovery actions and even payment suspensions that can cripple a provider. The response to one audit can affect future audits and actions by CMS. Once there is an overpayment there are several layers of review and appeal that can often take years to resolve. It is important to have attorneys who can navigate the process to get the best outcome; Lubell Rosen has the experience and knowledge to guide our clients to a successful outcome.
Medicaid Audits – The State of Florida Agency For Health Care Administration (AHCA) conducts audits on providers and often takes administrative action against providers such as payment suspension. There are several opportunities and steps during the audit process to address the audit issues and proposed findings. After a preliminary audit report (PAR), a provider has opportunities to address with AHCA the audit findings as well as proposed fines prior to a final audit report (FAR). The receipt of a FAR begins the administrative process to challenge an overpayment and fines. Lubell Rosen Attorneys represent our clients from the beginning of the process through the end to produce the best outcome for our clients.