Long Island Healthcare Audit Defense Lawyer

Healthcare Audit Defense Attorney in Long Island, NY

The healthcare industry is highly regulated. Billing practices, documentation, and compliance protocols are constantly reviewed, and even minor discrepancies can lead to an audit. When this happens to your company, a Long Island healthcare audit defense lawyer can help you move forward with confidence.

At Weiss Zarett Brofman Sonnenklar & Levy, P.C., we work with physicians, medical groups, and healthcare organizations throughout Long Island and its surrounding communities. Our team provides strategic guidance and thoughtful representation aimed at helping local providers succeed.

If you’re under scrutiny from a government agency or private payer, you need the help of a skilled legal professional who understands the legal and operational sides necessary to make healthcare organizations successful.

What Is a Healthcare Audit?

A healthcare audit involves a formal review of a provider’s billing, coding, and documentation practices. These types of audits can happen for many reasons. Some common triggers of a healthcare audit are listed below: 

• Coding inconsistencies
• Irregularities in billing
• High utilization rates
• Whistleblower complaints
• Random compliance checks

Who Conducts Healthcare Audits?

These audits are conducted by government entities, like the U.S. Department of Health and Human Services (HHS), the New York State Department of Health (DOH), federal Recovery Audit Contractors (RACs), the Centers for Medicare & Medicaid Services, and the New York State Office of the Medicaid Inspector General (OMIG). The OMIG office serving Long Island is in Hauppauge on Veterans Memorial Highway. OMIG is transparent about its audit goals.

In 2024, the HHS worked to recover $3.44 billion through audits, with billing fraud accounting for around 35% of healthcare fraud losses. Private insurance companies may also request an audit. Having an audit requested, though, does not necessarily mean there’s a problem. But once an audit begins, the process can move quickly, and it’s always better to be prepared.

Healthcare Audit Defense Laws and Regulations

Healthcare audit defense laws comprise both federal and state regulations. These include:

• False Claims Act. This prohibits submitting false or fraudulent claims for payment to the federal government. It may include billing for services that didn’t occur or misrepresenting medical necessity. Because of whistleblower benefits, private individuals are able to report these claims on behalf of the government.
• The Anti-Kickback Statute. This makes it illegal to offer, pay, or solicit valuables in exchange for referrals of services that may be covered by a government healthcare program.
• Stark Law. This restricts physicians from referring patients to other entities for financial gain. Violations can lead to the denial of payments or repayment obligations.
• Medicare and Medicaid billing rules. These establish strict requirements for documentation, coding, and reimbursement practices.

The legal framework of an audit varies based on the associated allegations, the payers involved, and which agency is conducting the review. Being proactive in your response can help you better mitigate consequences, including financial exposure, provider-patient relationships, and reduce the potential penalties.

Common Categories of Healthcare Audits

The kind of audit a provider faces depends on the agency conducting the review. An experienced Long Island healthcare audit defense attorney can help you understand what the organization is looking for and how to respond to it.

Some of the most common types of healthcare audits are listed below:

• Medicare and Medicaid audits. Government audits tend to focus on complying with federal billing requirements and may involve the Recovery Audit Contractors and the Medicaid Integrity Contractors.
• Private insurance audits. Insurance companies audit providers regularly with the intention of reviewing claims and coding accuracy. They also want to check that reimbursement practices are handled appropriately.
• Internal compliance audits. Some practices even conduct internal reviews. This can uncover issues that require legal guidance before they become bigger problems that trigger more serious audits.

Healthcare audits can result in consequences for your practice. There may be repayment demands or civil monetary penalties. In some cases, your practice may be excluded from Medicare or Medicaid services, which can significantly reduce the number of patients who can utilize your practice. Early intervention is key in protecting your practice and preventing disruptions to daily operations.

Healthcare Audit Defense Strategies

It’s important to develop effective healthcare audit defense strategies and a firm understanding of healthcare operations and regulatory requirements. Weiss Zarett Brofman Sonnenklar & Levy, P.C., reviews audit notices, identifying potential issues, and creating a tailored plan to support your practice.

Keeping open communication with auditors can prevent additional misunderstandings. In addition, careful responses can influence how the auditors interpret your claims or records. Working with an experienced attorney can not only help you through an audit but also reduce the risk of future audits taking place.

What to Do If You Receive an Audit Notice?

If you receive a notice that a healthcare audit has been initiated, you can further protect your practice by taking the following steps: 

• Review the audit notice carefully.
• Avoid submitting any documentation without a thorough review.
• Preserve relevant records needed for evidence.
• Limit internal discussions to key personnel within the practice.
• Contact a Long Island healthcare audit defense lawyer from Weiss Zarett Brofman Sonnenklar & Levy, P.C.

Why You Should Hire a Healthcare Audit Defense Lawyer?

The steps you take after you receive notification of an audit matter. When you hire a healthcare audit defense lawyer, you get a leg up against these larger auditing companies.

Weiss Zarett Brofman Sonnenklar & Levy, P.C., offers guidance when dealing with complex regulations and rules. We can interact with auditors to discuss records and explain practices.

Our team tailors strategies to each of our clients’ unique needs and situations. We work to reduce the risk of costly errors that can impact a practice’s daily operations and patient needs.

Contact Weiss Zarett Brofman Sonnenklar & Levy, P.C., Today

Weiss Zarett Brofman Sonnenklar & Levy, P.C., serves healthcare providers across Long Island, including those in Garden City, Mineola, and Brookhaven. We have a strong working relationship with local healthcare systems and regulatory agencies. It’s our goal to provide personalized support for our clients at every turn.

We know how much pressure can come with auditing procedures. Let us help reduce some of the overwhelming and surmounting stress by providing you with exemplary guidance and support throughout the process.

We take pride in our effective methods and approachable communication. We listen to your concerns and explain your legal options clearly. In addition, we offer reasonable rates that support more efficient representation for our clients. Contact Weiss Zarett Brofman Sonnenklar & Levy, P.C., to schedule a consultation with our Long Island healthcare audit defense lawyers.