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Los Angeles healthcare audits investigations lawyers

In the healthcare industry, it is not uncommon to have finances and expenses under question. As everyone in the healthcare industry is attempting to run their own businesses, they want to ensure they’re not getting ripped off or spending money they don’t need to.

But when it comes to audits and investigations in the healthcare industry, they can actually have completely different intentions. If you are a healthcare professional and you’re going through an audit or an investigation, you will need to have a full understanding of what that means.

What is a Healthcare Audit?

Audits in the healthcare industry happen all the time. In an audit, you may have a bill or price of service questioned. When under audit, you simply need to provide the individual auditing you with additional information to support your price and explain how you came up with the number that you charged.

Audits can be requested by insurance companies, patients, Medicaid and Medicare, or may happen at random. The auditing process will depend on who is auditing you and what their purpose for auditing you may be.

An audit does not necessarily mean that illegal activity or fraudulent intent was present. Instead, they may just believe there was an error in billing or they would like to understand why your prices have been raised or you charge more than other medical practices in the area. ‘

While under a healthcare audit, it is important that you fully comply with the auditors. Although many audits are simply looking for ways to save money for insurance companies, Medicare, or Medicaid, audits can also unearth potentially fraudulent behavior that can come with serious consequences.

If you are under audit, you will want to consider hiring a Los Angeles Healthcare Audits Investigations Lawyer. While you can get through the audit without the help of an attorney, having an expert by your side can ensure you come out in the right light. By helping you determine which information you need to provide and what you should do and say during the audit, you can move on with your medical business as normal.

What is a Healthcare Investigation?

A healthcare investigation is much more serious than a healthcare audit. For the most part, audits are harmless and are simply looking for ways to save some money. While an audit not working in your favor could mean you need to return some cash, you don’t really need to risk losing your medical license or your business. With an audit, those reviewing your finances aren’t necessarily looking for a illegal behaviors.

But in a healthcare investigation, reviewers are looking for potential fraud or other illegal actions. Rather than simply reviewing your books and billings, someone investigating your medical practice will be looking for evidence or signs that you have not been following the law.

Investigations can be a bit more difficult to spark, but they usually begin by a tip that your practice is committing fraudulent billing practices. This may come from an employee or may even come from an auditing service that has recently performed an audit on your business.

Depending on the findings of an investigation, you or other responsible parties could face additional trials and potentially jail time. If anything, an investigation could ruin the reputation of your practice and your doctors.

Because of the serious consequences that can come from an investigation, you won’t want to go through the process without a Healthcare Audits Investigations Lawyers. With the help of a lawyer from the very beginning, you and your legal team can develop a defense for what activities the investigators will find. Additionally, an attorney can help negotiate a settlement or reduce potential jail time and consequences if illegal activity is found.

If you are being audited or investigated, don’t hesitate in contacting a Los Angeles Healthcare Audits Investigations Lawyer to see what they can do for you. The sooner you get legal help on your side, the better chances you have at coming out on top. With expert legal attorneys to walk you through the auditing or investigation process, you can ensure you did everything you could to win your case.

Receiving a healthcare audit letter from the federal government can be a confusing and intimidating experience. Before fearing what this could mean for your practice, thoroughly read the audit letter to get a clear picture of which entity is making a request.

Several different government agencies are tasked with uncovering health care fraud to prevent further incidents. Under the direction of the Centers for Medicare and Medicaid Services (CMS), some agencies simply want further documentation or information that supports a claim.

Types of Audit Letters

There are essentially four types of audit letter that you can receive from the government:

Medicare Administration Audit – this is a request to conduct medical reviews for fee-for-service claims. If you receive this type of letter, additional documentation is needed to justify the purchase of medical equipment or medical services for the patient.
• Recovery Audit – this is an attempt to identify and correct any overpayments or underpayments.
• Zone Program Integrity Audit – suspected cases of fraud fall under this category where the auditor reviews medical records, conduct site visits and interviews. The focus is to determine if there is a pattern of improper billing.
• Comprehensive Error Rate Testing – this is a random selection and review of statistically identified rates of improper payments.

Your Next Steps after Receiving an Audit Letter

As a healthcare provider, you should prepare to answer the audit letter. Inform your staff about the possibility of auditors visiting the facility. Develop a plan for responding to the request in a timely manner.

There are times when the audit letter is set directly to an employee who is responsible for billing Medicare for the services you provide. Make sure your staff is aware that receiving an audit letter from the government is a possibility.

Responding to the audit letter is never an option. Based on which entity sends the audit letter determines the time period to deliver a mandatory response. Although a timely response is vital, you should never rush it.

Consider the reasons why the information is being requested. You also want to be aware of the risks to your practice if incorrect or damaging information is given to a government agency. Therefore, it is in your best interest to speak with a qualified healthcare audit lawyer.

Hire a Healthcare Audit Investigation Lawyer

Before deciding on how you and your staff should respond to the audit request, you should hire a lawyer. He or she will confirm what is being requested and what information you should submit. Generally, the time sensitive nature of these letters require establishing a relationship with a competent healthcare audit attorney before one is received.

In this manner, you and your legal counsel can prepare a thorough response the audit request. He or she knows the law and the repercussions of missing a deadline. Your attorney can also advise on what is appropriate to send. If the audit ends with a determination of fraud, you may have several options such as rebutting and requesting a redetermination.

Legal representation can help to keep your healthcare practice providing much-needed services to patients.


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Charle Butler
2021-03-12
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I was hesitant to hire the Spodek Law Group. I read reviews and knew they have a great reputation. However, I thought I would spend money and not see or speak to my attorney. From the beginning to end of my case Todd and the entire staff were available and willing to help. We worked towards and end result that was way above my expectation and Todd delivered. I am forever grateful for patience and long days and night spent working on my case. Thanks Todd and the entire team!
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My attorney at Spodek was Abigail. She was very knowledgeable and helpful with all my questions and concerns, as well as responsive. Her fees are affordable and Abigail took the time to make sure I understood everything relating to my case. I highly recommend Abigail and will request her services in the future.
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debabrata chakraborty
2021-03-03
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Todd A Spodek is the experienced and best criminal lawyer at USA. He is very professional and always respond on time. Alex also very cooperative and always help me. They took care me and my problem like family member. I am 100% satisfied for their professional service. My result was unexpected and amazing. They dismissed my case. I am really grateful to them. I will recommend you to go there if you want to solve your problem. I wish all the best for them.
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Truly appreciate the work the guys did!. Exceptional team & I know they care about each and everyone of their clients. I am super thankful to be referred to Spodek Law Group and I am grateful Todd & Alex were able to work diligently to achieve an outcome I am pleased with. Despite COVID they stayed on top of things and kept me informed every step of the way. Very thankful.
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Mike Moroff
2021-02-26
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I'm very satisfied with the services rendered by Todd, Alex and Mary Lou. I whole heartedly recommend Spodek Law Group . I've worked with and have retained other attorneys in the past with Todd's firm being the cream of the crop for many reasons. A very serious legal matter was resolved after a year's hard work and effort. Todd expertly guided me through the process and was able to navigate and make the good journey bearable as well as successful. Mary Lou initially provided excellent assistance before referring my case to Todd. Alex's support was effective and timely. The customer portal (MyCase) is an invaluable communication tool that also kept track of my case. Various aspects of my case were explained and there were several options provided but I made the final decision of how the case would be handled. The legal fee was reasonable considering the effort and amount of work plus it was a flat fee regardless of the length of time required to conclude my case. Todd made himself available to me and we had many scheduled meetings to go over the progress and to discuss the next steps. I felt more confident after many discussions with him. You will not go wrong choosing Spodek Law Group for legal matters.
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2021-02-24
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Being that it was the first time that I was in need of an attorney, I was afraid and hesitant and knew I needed the absolute best. It is beyond understood why Spodek Law Group has a reputation of being the top, if not the best law firm in New York. Alex and Abigail were there every step of the way even at the most unconvenient hours. I could not have asked for more. They are extremely good at what they do and they delivered much much more than just winning my case. A big thank you to Alex and Abigail for all the guidance and counseling and their upmost loyal support that extended far more than just legally. If you need the absolute best than don't hesitate to hire Spodek Law Firm.
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2021-02-24
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I cannot tell you how thankful I am to Todd and Alex for their hard work and dedication to my case. I had never been in any trouble before but I had an unfortunate event occur and in the midst of COVID-19 at that therefore I knew I needed a team that was dedicated to my success. Today- my case has been finalized and I’m walking away with no record and can continue life as a mother and a Grad student worry free. I cannot express enough gratitude for their assistance.
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2021-02-23
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I received a summons and called Spodek law group for a free consultation. Alex took my call and was very quick and responsive. He was available anytime through multiple platforms and very reassuring when needed. They are extremely organized and thorough. They got my case dismissed! I’m very grateful. Thank you Alex and Todd!

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