I am a huge fan of Knicole Emanuel’s Medicare & Medicaid legal blog. Check out her most recent post about whether auditors can “double dip” by overlapping concurrent audits.
EVERYONE is being audited. In fact, if you don’t think you have been audited, it’s likely you just haven’t been told by your institution that an audit is in progress. I was expecting some kind of Medicare audit, simply because everyone is being audited, so I kept calling various people at my hospital to ask if they had been notified of one. I even called medical records about once a month to see if anyone had asked for records. Everyone kept saying, “Oh No, Dr. Fife, we are fine.” Then months later, the corporate office downtown called to tell me that they didn’t understand why their response to an audit of hyperbaric charges did not seem to be going very well. (As I had feared, they had already failed to provide all the needed parts of the chart – which is what I was worried about in the first place.)
My point is – you are or soon will be audited, because claw backs of payment are the only thing funding the depleted Medicare trust fund coffers. And it’s likely that you will be audited more than once and by more than one entity. There are so many! There are Recovery Audit Contractors (RACs) looking at hyperbaric charges, just as there are Targets Probe and Audit (TPE) on just about every aspect of wound care, Comprehensive Error Rate Testing (CERT) audits and many others. The pandemic audit suspensions are over and the auditors have to go make up for lost time.
Knicole Emanuel is asking exactly what is legal for auditors to do when it comes to auditing the same claims for recoup money in multiple ways.
Check it out…and then try to find out what’s really going on at your institution.
And if you are willing to talk about what happened in your audit – anonymously is FINE – I will help you get the word out so that others can learn from your painful experience.