With overly aggressive health care auditors and health insurance companies constantly trying to improve their bottom line, health care providers are coming under greater scrutiny with respect to their billing. Add new technologies, such as algorithms designed to detect purported fraud, which are now being implemented nationwide, and it becomes increasingly clear that providers’ conflicts with health insurance companies, including Medicare and Medicaid, are only likely to get worse.
Dealing with audits and other so called “informal” requests from insurance companies is a complicated and extremely important process, which can have far reaching implications for a provider’s future medical practice. For this reason, it is important to have an experienced attorney help navigate you through the process and ensure that you receive the most positive outcome possible. Do not be fooled, health insurance audits often deny and retract funds paid for properly filed claims. Indeed, according to the AMA, more than 60 of claims denied by auditors were overturned in 2013. Due to the high error rates in audits and the often criminal implications of a negative audit result (health insurance companies often refer patterns of denials to the FBI/DOJ for further scrutiny), it is important that providers aggressively and persuasively respond to any audit, request for informal review or denial. To speak with an attorney about properly responding to a request for audit or informal review, or to discuss your legal options following a claim denial or retraction, contact The Callan Law Firm, P.C. now.