Tips #9 and 10 for Avoiding Medicaid Recoupment

The most common statements I hear from health care providers when they are going through Medicaid audits is “I did not know THAT was required,” or “No one told us that we had to do THAT,” or, my personal favorite, “I called DMA and they told me we were doing THAT correctly.”

Tip #9:

First, if you call DMA, document the conversation in writing.   Get the DMA representative’s name, title, and summarize the phone call in a safe place.  Then write a letter to DMA summarizing the information you received.

Write something like this: “Per our phone conversation [DATE], you stated that [insert explanation, i.e., you stated that electronic signatures complied with NC Medicaid policy, if I take the following steps…]”

If you take this precaution, filing a note of the conversation and following-up with a letter, the you ensure that DMA cannot, later, deny the conversation.  Remember, with oral conversations, no one remembers the conversation exactly the same.

Tip #10:

All health care providers, I venture to guess, at some point, needs to call DMA and ask a question.  If so, follow Tip #9.  But if you find that you or your employees often have questions, BE PROACTIVE.

Do not wait until the Medicaid audit to say, “I did not know THAT was required.”

How to be proactive? EDUCATE! Yourself and all your employees!

One of two ways:

1. Go on the DHHS website and find out when the State is giving educational seminars on Medicaid rules. And go to as many seminars as possible. While there, ask numerous questions;


2. Contact a Medicaid attorney (This is not an advertisement for myself, although I have done this for providers, but, please, research other Medicaid attorneys.) and have the Medicaid attorney come to your main office and give a presentation on Medicaid rules.  If you go this route, make sure the Medicaid attorney understands what type of Medicaid services you provide, even better, tell the Medicaid attorney your specific concerns regarding your practice.

The upside about attending DHHS seminars is that the seminars are free.  The upside of hiring a Medicaid attorney to come to your office, he or she can physically review some of your practices’ documentation for possible common mistakes.

Regardless, whatever you decide, do not do nothing until you received the Tentative Notice of Overpayment. It’s too late then. Be proactive in education.

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on February 3, 2013, in Division of Medical Assistance, Medicaid, Medicaid Recoupment, NC DHHS, North Carolina, Tentative Notices of Overpayment, Tips to Avoid Medicaid Recoupment and tagged , , , , , , , . Bookmark the permalink. 4 Comments.

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