CHICAGO – Medicare and Medicaid providers are more often than ever facing audits from government agencies, regulators, or their surrogates. When contacted by any such an entity the first step is to determine your potential liability and exposure. Too many times, I have seen providers expose themselves needlessly to a criminal prosecution based on what started out as an administrative investigation. The goal should be to keep the inquiry at the lowest level possible, which is why it is important to obtain counsel experienced in both criminal and civil matters.
Most commonly, audits start with a document request or visit from law enforcement seeking records related to Medicare beneficiaries. This first contact tells us something about the government’s posture. If the government sends out agents to obtain records that is signaling that the government may believe that the provider will alter records if given the opportunity to produce them at a later time, typically 30 days. A document request by mail typically signals a civil inquiry.
When submitting records it is imperative that all documents are reviewed prior to submission and are bates labeled so that the produced documents can easily be identified for purposes of an appeal.