[vc_row][vc_column][vc_column_text]In today’s world of tight budgets and questions about how healthcare dollars are being spent, the federal government has chosen to closely scrutinize Medicare. As a result, doctors, nurses, medical equipment companies, and others have found themselves the targets of Medicare audit investigations. Often done undercover or through other means that fail to let the healthcare provider know what is happening, these investigations often play a pivotal role in harming a provider’s reputation both professionally and personally. If you find yourself the target of an investigation such as this, you will need legal representation that knows and understands how to deal with these complex cases. That is why you need the legal team here at the law firm of Potashnik and Associates, since we have many years of experience dealing with these matters and are not intimidated by any aspect of a Medicare audit against our clients.
What Leads to an Audit?
In these situations, there are many factors that may lead the government to launch an investigation against a doctor or other healthcare provider. Such factors as having the government believe billing was done for services that were never rendered, or that records were falsified in order to justify the treatments given, can raise a red flag for investigators and thus have them decide to investigate. Unfortunately for healthcare providers, most of these investigations are done without their knowledge. In fact, in many instances the investigators will go undercover and visit a provider’s office, hoping to see or hear something that may incriminate the provider or their staff. On occasion, the investigator will go so far as to attempt to get the provider to perform an unnecessary procedure, hoping to bait them into an illegal act. However, when you have the firm of Potashnik and Associates as your legal counsel, you can be assured we will not let government investigators trick you into incriminating yourself. With our many years of experience with these cases, we know virtually every move investigators will make, and will work to ensure that all procedures are properly followed to let you maintain the legal rights to which you are entitled.
Who Participates in Audit Investigations?
When a Medicare audit is being conducted, a number of government agencies may be involved. Among these are the FBI, Department of Health and Human Services, Office of the Inspector General, U.S. Attorney General’s Office, and many others. Because of the number of agencies that may be involved, it’s imperative that you have strong legal counsel from the beginning. Needless to say, the investigation will be a very stressful event, and can lead to a person not thinking straight. But with us as your legal team, we will ensure you keep your wits about you as we stand by your side each and every step of the way. In many of these investigations involving a Medicare audit, numerous intimidation tactics may be used in an effort to get those accused of wrongdoing to admit guilt. However, no matter what is said to you by an investigator, you should always refrain from saying or doing anything that could make it harder to prove your innocence. We will work with you to make sure that all rules are followed very strictly, and that your innocence is maintained throughout the investigative process.
Don’t Minimize Your Risk
As a healthcare provider, it’s imperative that you not minimize the risk you may face of being audited at some point. Because the government has in recent years made it a priority to eliminate as much Medicare fraud as possible, investigators are always on the lookout for providers they feel may be in need of an audit. Unfortunately, in many audit situations, those accused of fraud had no intention of breaking any rules. However, due to the complexity of Medicare regulations, mistakes can be made quite easily. When this happens and the mistake is not rectified in a timely manner, investigators often assume the act was intentional. Once this determination is made, a healthcare provider can prepare for an onslaught of problems in the days and months ahead. Investigations of this nature are often extremely disruptive to the provider, staff, and patients, which can result in lost business and very low staff morale. That’s why it’s so important to retain Potashnik and Associates as your legal team during these proceedings, since we will be able to speak with you and then form a plan that will help you maintain both your business and staff morale during the investigation. Failing to do this can result not only in a potential guilty conviction at some point, but also the closing of your practice and the loss of your professional license. But with us at your side, investigators will known they are being watched, and in most cases will scale back their tactics in order to allow your business to continue indefinitely.
What To Do During an Audit
When you are the target of an audit, it’s imperative that you maintain your composure and think clearly about everything that is happening around you. Naturally, there are times when that may be easier said than done. However, that’s where we come in to assist you. Our team here at Potashnik and Associates understands what you are going through, and will take the appropriate steps to help you stay as stress-free as possible. We will advise you as to the actions you should or should not take during the process, which can prove crucial to your defense. In fact, some things that should never be done while an audit is being conducted include:
–Altering records prior to them being examined by investigators
–Falsifying medical or financial records
–Allowing the removal of files from your office by those who do not have a warrant
–Choosing to discuss the case with those who are not directly involved.
In these situations, we as your legal counsel will advise you as to the best approach to take when dealing with investigators. In our experiences, it’s best to put the burden of proof on investigators, since that will force them to spend more time searching for evidence. Meanwhile, that will let us work closely with you to plan a strong defense that will in time prove your innocence.
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