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Compliance Auditing: Should I “Lawyer Up?”

Judge-iStock_000013730450XSmallIn my last post, I talked about the steps you should take if the Office of Inspector General for the U.S.Department of Health and Human Services selects your practice for a Medicare reimbursement audit.

The key piece of advice I offered was for targeted chiropractors to seek professional help and not go it alone when the auditor comes calling. I detailed the benefits of hiring an experienced, licensed compliance consultant to assist you in the audit process, and I also briefly mentioned the possibility of hiring an attorney to augment your audit management team. In this installment, let’s talk a little bit more about the pros and cons of hiring an attorney.

When chiropractors facing an audit or post-payment demands ask me if they should hire an attorney, my short reply is always this: “Maybe.” I know, that’s not hugely helpful, but there’s more to it.

Unfortunately, you won’t immediately know if a lawyer will be necessary or useful during your audit. Some ethical attorneys will be up front with you about what they can or can’t accomplish for you, while others will be happy to let you pay them a retainer of a few thousand dollars just in case.

Given the range of attorneys’ fees, the decision to seek their help really becomes a numbers game. For example, if an auditor requests records and their investigation unearths a $437 fine because you billed, coded or documented a few services incorrectly, a $3,500 attorney fee will be overkill.

However, if a payer is accusing you of fraudulent billing and demanding $746,000 in reimbursements, then you should run—not walk—to an attorney’s office.

The choice of whether or not to hire an attorney is up to you, but if you choose to retain legal counsel, you should make sure the attorney is experienced in dealing with post-payment audits. This isn’t a job for your personal attorney or a family friend that has a law degree, even if these lawyers are accomplished litigators in the criminal realm. You want to find a healthcare attorney that has handled multiple cases (more than a dozen at minimum), and can clearly answer your questions, guide you through the process and promote a strategy that inspires confidence.

The price tag for these qualified attorneys can be steep—upwards of $250,000 for the most serious cases. These legal minds also can be tough to find. Many of the best attorneys are scooped up by hospitals and large physician groups that face post-payment demands of $100 million or more, so chiropractors with their more modest practices can sometimes seem like the little fish in the big pond.

However, if you are having trouble finding a qualified attorney, fear not—a consultant can be of assistance. Chiropractors facing post-payment demands and uncertain of how to proceed should consider scheduling a confidential Chiropractic Compliance and Audit Consult with me. Because I’m a licensed compliance specialist, I can review the problem and give you options.

Many times after going over the documentation related to the audit, appealing the demand can be handle without an attorney. If the amount is substantial or the HHS wants to play hard ball, then it may be time to “lawyer up.”

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