Medicare Audits, Appeals, & Fraud
We believed that if the two
physicians mentioned above had retained our firm during
the audit phase, their situations may have been different since we have experienced attorneys in Medicare and insurance litigation that understand Medicare audits.
A Medicare Audit should be taken seriously because not only does each audit has the potential for significant overpayment assessment, but also has the potential for criminal action, jail time and loss of license.
The current trend is that Medicare audits are outsourced to Recovery Audit Contractors, who are paid a contingency fee based upon what the Recovery Audit Contractor detects and collects. Although, the contingency fees are proprietary and unpublished, Recovery Audit Contractor costs are typically are 22% of the amounts alleged. Lately, our firm has received reports that although a physician has recently been
audited, it is not uncommon for another Recovery Audit Contractor to demand another audit.
If handled properly, a Medicare audit should not be cause for anxiety. Moreover, if handled properly by your attorney, a Medicare audit should have a minimal impact on your practice.
As a practicioner of Medicare defense, I wish to share with you
some information that is essential to your Medicare audit. Retaining an attorney at the audit stage is crucial.
If you receive a letter from Medicare, or a Medicare Recovery Audit Contractor, and the agency requests charts and/or files, immediately contact a law firm that deals with Medicare audits. Fax the law firm the letter that you received. Your legal team should review the charts and/or files before they are submitted to the Medicare Recovery Audit Contractor. Moreover, your legal team should meet with you and your
staff to explain
what
to do if an investigator
visits your practice or visits your staff at their homes.
Medicare Appeals
In a Medicare audit, the Recovery Audit Contractor reviews a small sample of claims and uses the results to calculate a projected overpyament for a specific period. Since, the analysis is not statistically valid, Medicare offers the physician three options: 1) pay their assessment; or, 2) waive appeal rights and provide additional evidence proving Medicare's assessment was improper; or, 3) have Medicare review
a larger
sample of charts/files while not waiving your right to appeal.
If you find yourself in this situation, contact our legal team to chose the best option for you.
Medicare Fraud
Medicare Fraud is a federal offense. It is very important to retain an attorney that is comfortable in the federal court, with a federal prosecutor, in front of a federal judge. Michael Cernyar is experienced in the federal court, is a member of several federal district courts, the Ninth Circuit Court of Appeals, and can represent clients throughout the United States.
Please feel free to call and meet for a Free Consultation in one of
our offices. I will meet with you to explore how best to defend and resolve
your case. Our 24-hour number is 800-409-7010.
Michael
K. Cernyar’s success as a Medicare defense lawyer is based upon his integrity,
mastery of the law, attention to detail and his willingness to
confront issues with the government head on.
Moreover, Michael K. Cernyar's reputation as a brilliant defense attorney has been recognized by others. Michael K. Cernyar has recently been interviewed by ABC, The Wall Street Journal, the Associate Press and other publications.
CALL TOLL FREE 800-409-7010
FOR A FREE CONSULTATION
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