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Medical Billing Audit Services

Lynette Byrd
Lead attorney
Lynette Byrd

In our current landscape, healthcare providers are often under a significant burden and great scrutiny when it comes to services provided and the appropriate manner in which to bill such services. While many providers may be able to manage their billing practices, others have chosen to place the burden on experienced professionals that understand the complexities involved in healthcare billing and appeals.

In healthcare alone, fraudulent claims amount to $400 billion dollars per year. As such, it is not uncommon for many U.S. agencies to look closely at a provider’s billing and coding practices. If you find yourself part of an investigation, it is important that you consult with a professional in order to absolve yourself from any perception of criminal wrongdoing. Many of these claims can involve the following:

  • Billing for Medically Unnecessary Services
  • Billing for Services Not Provided
  • Billing Unreasonably High Levels of Care (Upcoding)
  • Billing for Mutually Exclusive Services
  • Billing for Services Not Covered
  • Billing for Out-of-Network Services
  • Failing to Collect Copays.

Billing Practices. For healthcare providers, physicians and other business owners, the onus to monitor these claims is sometimes too burdensome to handle in-house. An in-house billing department requires trained and certified coders that are equipped and qualified to address inaccurate, incorrect or fraudulent claims. If having a comprehensive and in-house billing department is too cumbersome, it is imperative for providers and business owners to hire healthcare attorneys and other such experienced professionals in the case that the provider is the subject of an audit or an investigation.

At Oberheiden P.C., we have a dedicated practice devoted to handling healthcare practices and medical billing audit services. Our practice team includes former Department of Justice officials, former federal prosecutors in charge of escalated healthcare audits and fraud investigations, and as trusted consultants to hundreds of dentists, physicians, and mental health providers across the United States.

Medical Billing Compliance

The healthcare industry is the second most regulated industry in the United States. In operating in such a heavy-regulated industry, many would believe that physicians, providers and business owners would do their best to ensure that they are complying with federally mandated policies and procedures. The reality is, however, that medical billing mistakes can happen all too frequently. As this is the case, the only way to ensure that these types of mistakes are avoided, or addressed in time in order to avoid an audit or an investigation that may take you down a costly and lengthy road, is to have programs in place that demonstrate your commitment and intent to compliance. In fact, the Department of Health and Human Services (HHS) and the Office of Inspector General (OIG), the two enforcement arms of the United States Department of Justice (DOJ) in healthcare fraud cases, expect every provider and every clinic to incorporate and apply recommended compliance materials.

In addition, the burden of proof is on the providers to demonstrate that they are compliant with federal laws and regulations. In this case, putting safeguards in place with is an essential part of any practice. Failing to do so is a costly option that not only will place your business on the line, but your freedom. The penalties for providers can be astronomical, ultimately changing and destroying a practice and a career. All of this can be avoided when the proper compliance procedures are placed and adhered to at all times. Do not underestimate the effect of faulty billing practices!

What to do when you find yourself at the center of an investigation or an audit?

If you find yourself as the target of a healthcare investigation or audit, our recommendation is to act quickly and contact a professional. In doing so, you may be saving yourself a significant amount of time and money by addressing the investigation as soon as possible. Our team is able to examine and analyze the audit, determine the nature of the audit and then provide you with a complete understanding of the process and what to expect. We are here to ensure that any kind of exposure you may have is limited and resolved expeditiously.

The Importance of Putting Safeguards in Place.

Our team of seasoned and experienced medical billing professionals allows us to offer our services and expertise to healthcare businesses in order to avoid any kind of audit and investigation in the first place. We are available to quickly identify any mishaps that may occur as a result of lack of compliance procedures, staff members that may subject you to any kind of liability, and ultimately guide you to build a business that safeguards against these types of actions. When structures are put in place, billing mistakes are entirely avoidable and allow you to rest assured that you will not be subject to unwanted liabilities, including an audit. Allow our team to help and guide you through this process so you can focus on providing proven services!

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