Frier Levitt has recently secured three (3) large victories in payer audits originating out of New York State’s Medicaid program. In all three instances, the physicians were audited for services provided to patients who were Medicaid beneficiaries and part of a managed care organization in the state. As such, the audits fell under the auspices of a third-party auditing company that reviewed random claims and returned unfavorable results.
As is frequently the case, the auditor returned results that included an exorbitant overpayment demand, denying all claims that were reviewed and issuing an overpayment that was extrapolated beyond the audit sample.
Third-party auditors often employ aggressive tactics by issuing large overpayment demands paired with unreasonably short response deadlines. These demands are frequently accompanied by threats—ranging from manual claim reductions and civil litigation to veiled references to potential criminal fraud—all designed to pressure physicians into swift payment out of fear, rather than based on merit.
Here, the practices reached out to Frier Levitt instead of blindly paying the managed care companies. We immediately began discussions with the auditors, secured additional information to rebut the findings, and worked closely with the practices to ensure all the necessary documents were previously produced. As part of our robust defense, we also worked with vetted third parties who helped review the audit findings and determined, through an independent process, that the documentation supported the billing in most cases.
In these cases, significant issues with the underlying audit were discovered, ranging from incorrect attribution of monetary penalties to findings that were not supported by the coding rules. Working collaboratively with the third-parties and clients, Frier Levitt composed a comprehensive appeal to secure significant reductions in excess of 90% of the original overpayment demand in two of the cases. In the third matter, Frier Levitt convinced the auditors to walk back from 100% of the overpayment alleged.
In any case where a repayment must be made, Frier Levitt will work with the auditor to secure not just a reduced financial penalty, but to negotiate a comprehensive settlement agreement. These settlement agreements are essential to protecting client rights following an audit, as the insurance company will often attempt to secure just a payment of a lump sum following a reduced demand. Without a settlement agreement, physicians remain open to further audit or investigation for the same claims, and potential other legal exposure.
Frier Levitt has extensive experience working with physicians experiencing payer audits, both commercial and government, and has secured significant results with all types of insurance providers. If you receive a letter from an insurance company stating that you are under a payer audit, contact Frier Levitt to speak with an attorney about your options.
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