Legal Review of Your Audits and ADRs
Have you received an audit letter from a CMS contractor? Have you received an ADR from Medicare or Medicaid? DON’T PUT YOUR COMPANY AT RISK! You need an experienced healthcare attorney to review your responses BEFORE you submit them; otherwise, you could cause serious damage to your ability to fight a negative ruling later on. Even worse, you could inadvertently open yourself and your company to civil or criminal prosecution.
If You are a Provider, You are at Risk!
You MUST understand, audit requests and ADRs are designed to put you at risk, to make you vulnerable. One little mistake, oversight, or wrong word could put your company in danger of losing thousands, if not millions, of dollars in reimbursement. It could even put you at risk for criminal charges.
Audit requests and ADRs are no joke. Do not take them lightly, and do not try to do this on your own.
Good Providers Get Audited - and Destroyed!
I am a healthcare attorney. For the past several years, I have worked with healthcare providers just like you who have been targeted by the government and their contractors. I have seen good, honest providers hit with recoupment demands in the millions of dollars. Often, it is not due to fraud or abuse; it is simply because their documentation gave a government contractor room to deny their claims. You think your documentation is great, but contractors are trained to destroy good documentation. You think you have proven medical necessity, but contractors are trained to prove you are committing fraud - even when you aren’t!
Being a good provider is not enough...Having good staff is not enough...Having good documentation is not enough!
A Quick Warning
DO NOT respond to an audit request or ADR without having your responses reviewed by an experienced healthcare attorney. It could seriously cost you millions of dollars. It could even lead to criminal prosecution.
I am not trying to scare you. I am trying to warn you.
When I first started representing healthcare providers who were involved in government audits, I was very naive. I honestly believed that the investigators wanted the truth and were just looking for the “bad” providers. You know, those providers who create fake claims, steal their patients’ Medicare numbers, and milk the system. I thought auditors were just trying to catch the bad guys. I was wrong. I was very wrong.
I Learned My Lesson
One of my first cases involved a provider who thought they had great documentation. They were a large company, had thousands of patients, and had a great reputation. They were growing fast. Their patients loved them. Everything seemed great. As a large provider, they received their fair share of audit requests, unannounced surveys, and ADRs (“additional documentation requests”). Their in-house audit team looked over the requested documents, made sure they were complete, and sent them to the government audit contractor. They thought they were doing the right thing - until the FBI showed up at their office!
The FBI Doesn’t Play Nice
Within an hour, the company’s employees were forced to leave while the FBI seized computers, medical records, and office files. News reporters showed up at their office to cover this “fraudulent” provider. Competitors immediately started recruiting their staff members and patients. Websites and social media lit up with stories about how the FBI was raiding this provider’s office. Everyone thought, “If the FBI is there, it must be because they are committing a crime.” That provider lost a lot of business - approximately 20% of their census disappeared overnight. They will be fighting a legal battle for years and may even end up in court.
Audits Don’t Destroy just Bad Providers
You probably think that provider was a “bad apple”, but you’d be wrong. They are a good provider. I have seen their operation in detail. I have audited their records. I know their staff. They are a good, honest provider. One of the best, in fact. So, why did the FBI raid their office? Because of a disgruntled employee - and because of one medical record that was interpreted to the advantage of the government contractor.
The System Isn’t Fair, but It Is Dangerous
I know it isn’t fair. I know you try your best to provider great patient care. I also know that many government audit contractors receive millions of dollars in fees for the work they do. Some receive as much as 12% of the money they collect from providers. They have every incentive in the world to find problems in your medical records.
You may think your records are great. I can almost guarantee you they are not. Auditors are trained to find problems. They will seize on even the slightest indication of wrongdoing and they will cause you serious problems.
You Can Be Protected!
Lucky for you, our lawyers are trained to protect you. We know how auditors look at your records - and we know how best to defeat an audit before it even begins.
No, we cannot guarantee that you will not be audited. We cannot guarantee that an audit will not cause you problems. We can guarantee that you will have the best chance at being successful. We know how to protect providers from audits and ADRs - it's what we do!
Lawyers Are Expensive
Yes, hiring a traditional lawyer using traditional methods is very expensive. Very few attorneys understand the healthcare system, administrative law, reimbursement guidelines, and audit processes. Normally, you would have to hire a traditional lawyer and then pay them to learn - on your dime! Hiring an experienced healthcare attorney can be even more expensive, because they have minimum retainers and expect to take over every aspect of your compliance department. Unfortunately, they also can cause a ton of business problems due to ill-conceived “compliance programs” that are designed to create more work for the lawyer, while actually increasing the risk for the provider!
A Better System...And Better Lawyers!
Our Audit Shield Subscription was designed to give you access to an experienced, knowledgeable healthcare attorney for a fraction of the traditional cost. We can do this because we do things differently than most law firms:
We specialize in healthcare audits. We have systems, processes, and people who know how to review audit requests and ADRs quickly to make sure you are protected.
Don’t be stressed out. Don’t guess at the right audit responses. Don’t “google” the answers. You will be prey for a hungry auditor.
With our Audit Shield Subscription, you will go from stressed out and worried to confident and in control. You will go from being the hunted (by the government), to the hunter (growing your business with confidence). You will go from high risk to high security.
For just $199 a month, you get an experienced, knowledgeable healthcare attorney who will:
Review all of your audit requests and ADR responses before you submit them to the government, so you know you didn’t overlook anything
Answer all of your audit and ADR questions, so you can respond confidently
A subscription to our Audit Shield newsletter, with tips and tricks for staying compliant, industry news, and audit strategies
Priority access to even more advanced attorney services, such as survey representation, public relations management, and corporate compliance
20% discount on books, manuals, and other services from The GoodLooking Company and Kovar Law
If you are a healthcare provider, you will be audited. Do NOT respond to an audit request or ADR without an Audit Shield subscription. It could save you millions. It could save your company. It will definitely give you peace of mind, confidence, and answers.