Understand the complexities of federal health care program payments and make sure your organization is getting the reimbursement it deserves.
State Medicaid programs rely on a number of 'program integrity' mechanisms to detect and investigate fraud, ranging from criminal investigations to a number of different audit procedures. However, like their Federal Medicare counterparts, Medicaid audits may be aggressive and result in demands for large sums of money. This topic will cover several common types of Medicaid audit processes, describe how they affect providers, and what they can do to get ready.
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Why Lorman?
Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.
Agenda
Overview of Medicaid Program Integrity Functions
- Medicaid Agency Fraud Detection and Investigation Program
- Medicaid Fraud Control Units
- Medicaid Integrity Program
- Medicaid Recovery Audit Contractors
How a Post-Payment Audit Works in General Terms
- Scope of Review
- Notice to Providers
- Submission of Records for Reviews
- The Audit Process Itself
- Collection of Overpayments
- Appeals
"Sticky Areas" in the Audit Process
- Provider Burdens
- Accuracy
- Tranparency
Preparing for and Dealing With an Audit
- Conduct an Internal Assessment
- Know Where Previous Improper Payments Have Been Found
- Dealing With the Auditing Entity
- Being Aware of Deadline
- Knowing Appeal Rights
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Why Lorman?
Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.
Credits
OnDemand Course
This course was last revised on December 5, 2018.
Call 1-866-352-9540 for further credit information.
This program does NOT qualify, nor meet the National Standard for NASBA accreditation.
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Why Lorman?
Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.
Faculty
Hugh M. Barton
Hugh M. Barton, P.C.
- Founder of Hugh M. Barton, P.C.
- Former Section Chief in Texas Attorney General’s Medicaid Fraud Control Unit
- Former Assistant General Counsel for Texas Medical Association
- Board Certified in Health Law by Texas Board of Legal Specialization
- Past Chair of the Health Law Section of the State Bar of Texas
- Frequent speaker and writer on health law topics
- Practiced health law since 1984
- Can be contacted at 512-499-0793 or [email protected]
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Why Lorman?
Over 34 years and 1.4 million customers worth of experience providing continuing education. Our passion is providing you world-class training to help you succeed in business and as a professional.
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