The government continues to aggressively pursue allegations of Medicare fraud throughout the country. This crackdown is part of a broader initiative to protect taxpayer dollars and ensure the appropriate use of Medicare funds. Although a noble goal, physicians can find themselves targeted and under scrutiny during a Medicare audit. Medical professionals who find themselves in this situation may prepare for questions about their record keeping, billing practices, and even the care provided. They may prepare for fees and fines, but there can be an additional consequence – the audit could trigger an official investigation by the state licensing board.
What triggers Medicare audits?
The government will watch out for red flags, such as high billing volumes or patterns that deviate from the norm, frequent use of high-cost procedures or services, or patient complaints or whistleblower reports. You can counter these allegations. To do so, it is important to maintain accurate and detailed documentation for all services provided. It is also helpful to regularly review and update billing practices.
Why would this trigger an investigation by the state licensing board?
A Medicare audit might trigger an investigation by the state licensing board if it uncovers evidence of fraudulent billing practices, such as overbilling, billing for services not rendered, or upcoding. Such actions likely violate both federal regulations and state medical practice standards. If the audit reveals patterns of negligence or substandard care, it could also raise concerns about the physician’s competence and adherence to professional standards.
How can I protect my medical license?
Those in this situation are wise to act to protect their interests. This can include:
- Seeking legal counsel with experience in healthcare law to guide you through the investigation,
- Cooperating with investigators while ensuring your rights are protected, and
- Gathering and organizing all relevant documentation to support your case.
A failure to take the matter seriously can have dire consequences as the board could suspend or even revoke your license. Do not hesitate to reach out for assistance. By delegating the matter to legal professionals you can focus on your practice and serving your patients while counsel works to protect your interests and mitigate the impact of the allegations.
Attorney John Rivas is responsible for this communication.
