Tip #12 to Avoid Medicaid Reimbursement/Be Proactive in the Era of Medicaid Audits

Looking back on all my posts, I realized that I have not written a “Tip” lately.  But when I started thinking about my “Tip,” I realized my Today’s Tip is more of a “Tip to Be Proactive in the Era of Medicaid Audits.”

So, I am officially changing the name of my “Tip Blogs” to “Tip #12 to Be Proactive in the Era of Medicaid Audits.” Poof! It’s changed.  (Also, I reserve the right to change the title back at any time.)

My Proactive Tip Today:

No.1: Make sure that your liability insurance covers attorneys fees!!!

No. 2: Make sure your insurance, if it does cover attorneys’ fees, that your insurance allows you to choose you attorney.

First, get a copy of your insurance and read it.  You are looking to make sure that your insurance covers “regulatory audits.”  Here is the important catch…even if your insurance claims to cover regulatory audits, if you receive a Tentative Notice of Overpayment, or a Notice of Prepayment Review, the correspondence will, in some place, state that the action (whichever action it is) is “based on credible allegations of fraud.”  Is that actually a true statement? I don’t know. Maybe. Maybe not.  The result, however, is that some insurance companies claim that, because the Tentative Notice of Overpayment or Notice of Prepayment Review is based on credible allegations of fraud, that attorneys’ fees are NOT covered because fraud is an intentional action.  You will notice that your insurance does not cover actions for fraud.

The insurance companies do not understand that these Notices of Overpayment and Prepayment Review ARE NOT FRAUD. Instead, we are dealing with paperwork nit-picking. And, in many cases, erroneous, paperwork nit-picking.

Second, make sure that your insurance allows you to choose your attorney. What good is an insurance that covers attorneys’ fees, but only covers the fees for these certain 10 lawyers, who have never seen a Medicaid Clinical Policy, graduated law school 2 years ago and passed the Bar on their 4th attempt.  I shiver at the thought.  (Remember, it does not have to be me that you hire, just hire a good, knowledgable attorney).

After realizing many of my clients were in-need of an insurance company/plan that would cover attorneys’ fees for attorneys’ of their choosing, after a bit of research, I found an insurance broker that I recommend.

Here’s the caveat: If you are already undergoing a Medicaid audit, or already on prepayment review, it will not help you to change your insurance at this point.  It would be like a “pre-existing condition” in health insurance.  So this Tip is those health care providers, who are not undergoing an audit currently, but wish to be proactive in protecting their interests.

So, if you are interested in obtaining a liability insurance that will 100% cover your attorneys’ fees, contact:

Edward M. Smith, CIC
Senior Vice President
A Marsh & McLennan Agency LLC Company
One S. Jefferson Street,
Roanoke, VA 24011
Direct:  540-767-4053
Fax:  540-342-9747

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on July 8, 2013, in Division of Medical Assistance, Health Care Providers and Services, Liability Insurance, Medicaid, Medicaid Audits, Medicaid Costs, NC DHHS, North Carolina, Not in Good Standing, Post-Payment Reviews, Prepayment Review, Regulatory Audits, Tentative Notices of Overpayment and tagged , , , , , , , , , , , , . Bookmark the permalink. Leave a comment.

Leave a Reply

%d bloggers like this: