Medicare/Medicaid Audits

The regulations and policies governing Medicare and Medicaid providers can be exhaustive and arcane. Few providers survive a program audit - whether by the local Medicare carrier, the Office of Inspector General, the Division of Medical Assistance or its contractors - without a claim of some overpayments. Requested records are subjected to rigorous review and both Medicare and Medicaid steadfastly adhere to the policy that failure to follow rules and regulations to the very letter, and lack of complete documentation, are grounds to deny all reimbursement for the service. Both programs employ an extrapolation theory, where a mistake uncovered in a small number of claims can quickly catapult into a substantial portion of the provider's total reimbursement revenue. Dwyer & Collora, LLP's attorneys have been particularly effective in this arena, limiting providers' financial exposure, proposing plans of correction as an alternative to harsh sanctions, and persuading the auditing agency not to refer providers to law enforcement agencies for further investigation. 

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