Audit investigations can and typically are scary for those who are being investigated. They are especially nerve-racking when you have no real understanding as to why you have been targeted. As someone who handles governmental investigations on behalf of our clients, I wanted to provide you with some basic Do's and Don'ts of how to handle an audit investigation.
Keep in mind that there is no "one size fits all" when it comes to responding to an audit investigation. But, following these simple steps should assist you in being better prepared to handle this situation if and when it comes up.
Contact legal counsel immediately and ensure that he/she thoroughly understands healthcare law;
If there has been correspondence between you and a Carrier, MAC, RAC, CPIC, MIC, etc. make sure you have all of those communications available to provide to your attorney so they can begin to put the pieces of the puzzle together;
Gather all documentation from third-party audits (those companies you hired to ensure you were compliant) and provide those to your attorney;
Be open and honest with your attorney about any potential areas where you may have done something wrong or if you were cautioned about a potential problem(s) by an outside consultant;
During meetings, take copious notes so that when you have to refer back to a previous conversation, you have solid information;
If you have internal policies and procedures regarding coding, billing, documentation, cloning, modifier usage, protocols for ordering diagnostic tests or laboratory tests, have those available;
If you have a corporate compliance program with education logs, have those available;
If you are contacted by someone from a governmental agency or payor via mail, email, phone or in person regarding setting up a time for an interview, be courteous and accommodating.
Always provide them with just the facts
Don't think you can represent yourself;
Don't communicate in writing or verbally with anyone from a governmental agency or payor without legal counsel present;
Don't be belligerent or confrontational with anyone from a governmental agency or payor;
Don't use foul language to convey you are upset;
Don't hide information from your attorney or pretend you forgot about some critical detail(s);
Don't share information about a pending investigation with anyone other than those who need to know and your attorney;
Don't self-disclose to Medicare without first consulting with an attorney who understands and can guide you through the process. Not every situation requires a self-disclosure;
Don't start transferring assets out of your name or putting your kids, spouse, or other family members' names on your house, bank accounts, etc.;
Don't flee the country;
Don't ever give them something to quote you on;
Don't ever give them more than what they are asking for;
Don't use a "Compliance plan in a box"
The lists above are, of course, not complete lists of do's and don'ts as these can change depending on your situation. However, using these as a guide will ensure your odds of making a mistake throughout the investigation process are greatly reduced.
This Week's Auditing & Compliance Tip Provided By:
Sean M. Weiss is a Partner and VP/Chief Compliance Officer for the Department of Audit and Regulatory Compliance for DoctorsManagement. The above information is not meant to serve as legal advice. Sean Weiss is not an attorney, nor does he play one on TV but he does stay in Holiday Inn Express' a lot. For more information about Sean M. Weiss or to see if DoctorsManagement can assist you with an issue, contact us at firstname.lastname@example.org