In follow up to a previous posting, the Wall Street Journal recently reported that the Medicare Recovery Audit Contractor Program has identified 1.03 billion dollars of improper payments over the past three years, about 992.7 million dollars of which were over-payments by Medicare. While the Recovery Audit Contractor Program is currently underway in six states, Medicare is in the process of expanding the program’s scope nationally. With this increasing scope, the risk of being audited is also likely to increase.

In the event a provider is subject to a Medicare or other third party payor audit, it is important to review the documentation provided by the auditor and take the steps necessary to prepare an appropriate and timely response. If the steps required to respond to an audit are not properly followed, there is a risk that the provider may forfeit certain rights. If a provider is subject to an audit, the services of an attorney or other professional familiar with the audit process can be of significant benefit. 

Paul Welk