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Every healthcare provider who files Medicare claims, whether a hospital, physician’s office, home health agency or nursing home, can expect to be audited by the federal government. Audits are increasing because Recovery Audit Contractors (RACs) are contracted by the government to find overpayments and underpayments made to healthcare providers. Private insurance carriers like Blue Cross, United Healthcare, Cigna and others are auditing as well. The False Claims Act imposes liability even if the person submitting the claim does not have actual knowledge that a claim is false.
In many cases demands for repayment are calculated from extrapolated audits, leaving the provider to defund huge amounts based on a small sampling of case files. You could be liable to pay thousands or hundreds of thousands of dollars.
How can you protect yourself? You should have multiple lines of defense. First, have an ongoing system in place for conducting your own internal audits to catch any overpayments before a government audit occurs. Even with preventative measures, you will probably still be audited. That’s why Physicians Regulatory Audit Insurance is your best defense against government audits. The MedRisk Physicians Regulatory Insurance Program includes Audit Insurance coverage of $1 million for single practitioners and up to $5 million for large group practices, retroactive for up to 6 years.
Let our experienced team help you obtain this all-inclusive coverage so you can feel safe knowing when a government audit occurs, you are protected.
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