When an Audit is Performed by a Third Party with a Financial Incentive

When a third party conducts an audit, they get to keep a percentage of the money they recover. They may even claim that some of their audits result in discovering that you are underbilling. This would theoretically result in you getting more money from the carrier. Please, raise your hand if this ever occurred during one of your insurance audits.

Remember the Anti-Kickback laws? Remember all those restrictions on self-referrals? They are designed to take the financial incentive out of ordering tests and treatments. Yet, these third-party audits do exactly that for the insurance company or government and they are encouraged by regulations and statutes. Often known as RAC Audits, MAC Audits, MIC Audits, Medicare and Medicaid Audits, their sole purpose is to recover money from you. The party facilitating the recovery gets rewarded for it by obtaining a percentage of what they claim is the overpayment. Legal advice can be of great value in these audits.

Lawrence F. Kobak, Esq.
Senior Counsel
Frier Levitt
ATTORNEYS AT LAW
101 Greenwich Street, Suite 8B
New York, NY 10006
(516) 410-2835
lkobak@frierlevitt.com
www.frierlevitt.com