An audit or investigation for a medical practice can mean serious business. Depending on the circumstances surrounding the audit or investigation, there could be severe consequences if fraud or other illegal activity is discovered.
But in order to get through an audit or investigation and come out with your practice and reputation in tact, you need to understand and follow the correct practices. In many cases, that means working with a California Healthcare Audit Investigations Lawyer.
What are Healthcare Audits and Investigations?
If your practice has never had an audit or investigation before, you may be confused about what the terms mean and what the processes that follow those terms may look like. In many situations, individuals will use the terms audit and investigation interchangeably. Unfortunately, this can be misleading because they are actually quite different.
What is a Healthcare Audit?
Like with any other business, an audit serves the purpose of looking a little more deeply into the purchases and behaviors of the company. Audits will take a look at the way money is being spent, what is being charged, and whether or not those numbers make sense.
A healthcare audit can begin for a number of different reasons. One of the most common reasons an audit may start is if an insurance provider believes that the practice is overcharging for their care and services. An assumption that the practice is overcharging does not necessarily mean fraud is being committed, just that the insurance provider would like additional information to support the price charged.
This same idea applies to audits looking at equipment, services, or products purchased for the medical practice. If an audit on purchases is held, the organization or company requesting the audit simply wants to know if those purchases are legitimate and that they are needed.
But someone else does not always need to spark an audit in the healthcare industry. In an effort to reduce the amount that medical practices are spending, random audits can be performed. These audits aim to take a look at what purchases are being made, what prices are being charged, and if the medical practice can do anything to reduce the amount of money they are spending.
Using an Attorney During a Healthcare Audit
While an audit does not automatically mean serious consequences are around the corner, you may still want to consider hiring a California Healthcare Audit Investigations Lawyer. Having an attorney on your side can ensure you comply with the audit, you’re presenting all useful and necessary information, and that the auditing process runs smoothly and efficiently.
What is a Healthcare Investigation?
Like a healthcare audit, an investigation looks into the way your medical practice is spending money or charging patients and insurance providers. But unlike an audit, an investigation assumes that fraud or illegal activity has taken place.
An investigation may begin if a insurance company or patient believes that the amount they were purposefully charged too much or that the medical practice has suspicious billing patterns. Investigations can also stem from audits if something was discovered during an audit that could potentially contain fraud. Investigations may also begin if an employee or other individual at the medical practice alerts law enforcement agencies that they may not be following the best billing practices.
Because an investigation assumes that illegal activity has occurred, it is always advised to use a California Healthcare Audit Investigations Lawyer. Your lawyer can help protect you by educating you on what you should do or say during your investigation and prevent you from making comments that may get you into trouble later down the road.
A California Healthcare Audit Investigations Lawyer can also help you develop a defense if your investigation should take you to court. Depending on what is found during the investigation, responsible parties may be facing additional court time, including professional sanctions, civil litigation, or even criminal prosecution. If any of these additional actions occur, you will need an attorney.
You should contact a California Healthcare Audit Investigations Lawyer as soon as you are aware of an audit or investigation.
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