Weiss Zarett Brofman | Sonnenklar & Levy, P.C. | Attorneys At Law

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Health Care Audit Defense Attorneys

The attorneys at Weiss Zarett Brofman Sonnenklar & Levy, P.C., routinely represent health care providers who are preparing for or responding to health care audits or state and federal government agency site visits.

If you are a medical professional who is under investigation, or your health care practice is facing an audit or has an impending site visit, our Medicare audit attorneys and health care audit defense lawyers in New Hyde Park can help you protect your rights and interests.

Different Types Of Government Audits

In the world of medical practices and services, there are a number of different state or federal regulatory agencies that might conduct an audit. Our lawyers support medical professionals and practices who are facing audits and investigations involving:

  • CMS – Centers for Medicare & Medicaid Services
  • RAC – Recovery Audit Contractor Audits
  • ZPIC – Zone Program Integrity Contractor Audits
  • MAC – Medicare Administrative Contractors Audits
  • Medicaid (New York)
  • OMIC – Office of Medicaid Inspector General
  • MFCU – Medicaid Fraud Control Unit
  • DOH – New York State Department of Health (DOH)
  • NY AG – New York State Attorney General
  • OIG – United States Department of Health and Human Services, Office of Inspector General
  • IRS – Internal Revenue Service
  • DOJ – United States Department of Justice
  • Commercial (Managed Care) Payor Audits and Investigations

Regardless of what type of government agency or private carrier is investigating you or your healthcare practice, our lawyers can provide support. We will help you protect your rights and interests. The attorneys at Weiss Zarett Brofman Sonnenklar & Levy, P.C., have experience assisting health care providers and facilities with respect to all types of audits and physician investigations.

Stages Of A Health Care Audit

A health care practice can find themselves facing an audit for a number of different reasons, including a patient complaint. An audit may also be initiated as the result of a routine review. Regulatory agencies will use algorithms to analyze statistics. For example, a computer will generate a report with the most prescriptions for opioids or unusual billing practices and this could trigger an audit. There are several stages to a health care audit, including:

  • The initiation of the audit: An audit is initiated by a patient complaint or a regulatory review.
  • The case is assigned to an auditor or fraud investigator: After the initial review, if there are credible findings the case will move forward. If a fraud investigator is assigned, your medical practice will be under scrutiny and you should take this seriously.
  • Request for medical records and patient charts: An audit or investigation may include requests for medical records.
  • Review of documents and records: Investigators and auditors take time to review all of the relevant documents.
  • Resulting decision: After the auditors or investigator has conducted a review, the file could be closed or referred on to law enforcement.

If you are aware that a patient has filed a complaint with a regulatory agency, do not hesitate to seek legal support and representation before you become aware of an impending audit or investigation. The sooner we get involved, the sooner we can help you protect your rights.

Legal Support For Government Agency Audits And Investigations

Our attorneys are experienced health care litigators. Our litigation lawyers assist clients in myriad ways, including:

  • Responding to subpoenas and requests for information
  • Responding to and appealing audit reports and overpayment demands
  • Helping to remove clients from pre-payment audit reviews
  • Negotiating settlements and corporate integrity agreements
  • Developing corrective action plans
  • Attending administrative hearings at both the state and federal level
  • Representing health providers in civil court litigation on such matters

We routinely work with billing and coding experts, as well as statistics experts in order to prepare your case and protect your rights.

Audits And Physician Investigations FAQs

At Weiss Zarett Brofman Sonnenklar & Levy, P.C. we know that if your health care practice is facing an audit or you are a physician who is under investigation, you probably have a lot of questions.

Here, our health care audit defense attorneys answer some of the most frequently asked questions. For answers to questions regarding your specific situation, we invite you to schedule a consultation appointment.

How can a health care audit negatively affect me?

Most audits do not result in any sort of disciplinary action, but there is always the possibility of having to pay a fine, adjust the structure of your practice or even having your practice shut down entirely as a worst-case scenario.

How do I avoid audits and physician investigations?

The simplest way to avoid audits and investigations is to abide by all local, state, and federal laws and regulations that relate to your practice. Our health care transactional lawyers help medical professionals review their practices to ensure compliance.

What should I do now that an audit has been called?

If you have received information that you are going to be audited, contact competent legal assistance. You may also want to start compiling the relevant documents and testimonies for your own reference and to help your legal team.

Consult A Health Care Audit Defense Attorney

Audits and physician investigations are almost always an annoyance or hindrance for any medical practice, but Weiss Zarett Brofman Sonnenklar & Levy, P.C., is prepared to walk with you through every step of the process.

We take on the legal hurdles for you so you can focus on your health care practice and keep your attention on improving the health and life outcomes of your patients. Contact us today through our website, or by calling us at 516-627-7000 to schedule an initial consultation appointment.