Long Island Medicare and Medicaid Audits Lawyer

Experienced Medicare and Medicaid Audits Attorney in Long Island

Medicare and Medicaid, as federal healthcare programs, want to make sure their services are being billed and used properly. Several agencies conduct audits and investigations when there are concerns about billing, reimbursements, or other payment issues. While audits can be routine, they can have serious consequences if any issues are found. It is crucial that healthcare professionals work with a Long Island Medicare and Medicaid audits lawyer to fully prepare themselves.

Weiss Zarett Brofman Sonnenklar & Levy, P.C.: Support in Medicare and Medicaid Audit Cases

It’s essential that you work with legal representation who not only understands governmental audit processes but also has a deep knowledge of healthcare law, along with how it impacts different medical professionals.

At Weiss Zarett Brofman Sonnenklar & Levy, P.C., we have this knowledge and experience. For decades, our team has represented providers who have received notice of Medicaid or Medicare audits. We care about our clients and understand how important these cases are to their futures and livelihoods. Our attorneys can prepare for an audit and navigate the aftermath, including appeals when necessary.

Our firm prides itself on reasonable rates, diligent legal care, and a substantial understanding of Medicare and Medicaid audit laws. When you work with our firm, we don’t pass your case off to a less-experienced employee but handle your case ourselves. We can safeguard your rights and aim for the ideal outcome to your case. Our attorneys are experienced with the local 10th Judicial District serving Long Island, and we know how to deal with local federal investigative agencies.

Understanding Medicaid and Medicare Audits

Audits review financial information and other records to make sure there are no discrepancies. They also check that your healthcare practice meets business, employment, healthcare, and other regulatory standards. Many agencies may conduct an audit on your practice or other healthcare facility. Some of the primary Medicare and Medicaid auditing agencies include:

• Centers for Medicare & Medicaid Services (CMS)
• Recovery Audit Contractor (RAC)
• Medicare Administrative Contractors (MAC)
• Medicaid Integrity Contractors (MIC)
• Medicaid Fraud Control Unit (MFCU)
• Office of the Medicaid Inspector General (OMIG)
• Zone Program Integrity Contractor Audits (ZPIC)

At Weiss Zarett Brofman Sonnenklar & Levy, P.C., we can navigate audit cases from any of these agencies. We can also help with Medicaid, Medicare, and other healthcare audits and investigations filed by many other agencies, including the following:

• New York State Department of Health (DOH)
• New York State Attorney General
• U.S. Department of Justice (DOJ)
• U.S. Department of Health and Human Services, Office of Inspector General (HHS – OIG)
• Internal Revenue Service (IRS)
• Commercial Payor and Managed Care Audits and Investigations

Our firm has experience with many types of governmental agencies, both state and federal, as well as private audit companies.

What Could Trigger a Medicaid or Medicare Audit?

It’s important for medical providers to understand what triggers audits. For some, these billing or service triggers are simply a part of their unique healthcare operations. These professionals need to be aware of how these triggers can be a risk, along with how to clearly document them in preparation for an audit. Medicare and Medicaid audits can be triggered for many reasons, including:

• Billing outliers: Many unusual billing volumes or patterns can cause an audit. These include submitting Medicaid or Medicare claims at a higher frequency compared to others in your field, specialty, and region. A sudden increase in this billing without having more patients can also be a red flag. Billing at after-hours times can also trigger an audit, as can a gap or an overlap in the dates when services were rendered and the billing was made.
• Up-coding indicators or other coding outliers: Frequent use of certain billing codes or services outside normal usage can trigger an audit. This is especially true when those overused codes are high-reimbursement codes or those that have historically been used in healthcare fraud and abuse.
• Employee or competitor complaints: Reports that are made by employees or competitors can also trigger a Medicaid or Medicare audit. Current or former employee whistleblower cases can be based on billing issues or record-keeping mistakes. Competitors can also report issues about improper coding or other errors. Proper documentation and regulatory compliance plans can prevent these claims. When false complaints are made, your attorney can gather existing evidence of that.
• Patient complaints: Patients can make complaints for numerous reasons, from being billed for services not rendered to services appearing on their summary that they didn’t receive. These complaints can lead to an audit to determine if there is Medicaid or Medicare fraud occurring.

What Are the Possible Consequences of a Medicare or Medicaid Audit?

You should not take an audit lightly, even if you think the complaint or other cause for the audit has no merit. In one of the worst-case scenarios, a Medicaid or Medicare audit can result in the suspension of your professional license, especially if an audit leads to an investigation by a professional licensing board. In New York, there were over 800 adverse actions taken against medical providers in 2024, including nearly 300 against physician MDs.

Other potential consequences of an audit can be serious, including:

• Repayment demands, which are more common if billing errors led to issues across your entire payment history
• Damages for errors that can be extrapolated across all similar claims, even those without errors
• Fines for errors, as well as interest accrued in some cases
• Withholding and suspending ongoing and future payments until the unpaid Medicaid or Medicare amount is recovered, causing severe financial strain for businesses
• Requiring future payments to be manually reviewed, along with taking other increased scrutiny measures, making reimbursements take longer to process
• Exclusion from Medicaid, Medicare, and other federal health programs, impacting a significant portion of patients
• Additional audits in the future
• Referrals to the DOJ or HHS – OIG if the audit uncovers potential evidence of healthcare fraud
• Harm to your professional reputation and practice

You should immediately hire a Medicare and Medicaid audits lawyer when you are notified of the audit, even if there has been no wrongdoing or errors. An attorney can provide reassurance prior to the audit, or they can report any discrepancies, potentially limiting the worst of the consequences. At Weiss Zarett Brofman Sonnenklar & Levy, P.C., we can fight for you and the future well-being of your practice.

Consult a Long Island Medicare and Medicaid Audits Attorney

If you need legal support for an audit, contact Weiss Zarett Brofman Sonnenklar & Levy, P.C., today.