Medicaid Audit & Compliance Services
Let TCORS assist your organization with understanding the Medicaid audit process and how proper billing, coding and documentation procedures and practices can help you reduce audit exposure within your specific provider area.
Periodic Record Reviews
Allow TCORS’s experienced staff to periodically perform mock audits of a sample of your paid Medicaid claims. These audits are designed to replicate an actual Medicaid audit with the intent of discovering potential billing, coding, and documentation errors that could result in adjustments in a real Medicaid audit. Using the results of these mock audits, TCORS can then help your organization set up proper controls to prevent the errors from reoccurring and costing your organization substantial disallowances in extrapolated audit adjustments.
Assistance During The Audit Process
Allow TCORS to assist your organization during the DSS audit process. We can help your organization prepare for the audit, represent you during the audit, develop defenses in response to any draft and/or final audit reports, negotiate settlements and payment plans, help prepare documents for the DSS informal review process and provide representation during the informal review process.
Appeal Audit Decisions
Effective July 1, 2010 the Connecticut General Statutes Section 17b-99(d) was amended to allow providers the ability to appeal the Department of Social Services (DSS) Medicaid Final Audit Findings to the Connecticut Superior Court. As a full service law firm, TCORS is in a position to represent your organization in this appeal process. We have over 40 years of experience representing numerous hospitals across the State of Connecticut at DSS Administrative Hearings, Appeals in Superior Court and Appellate Court on Medicaid and Saga claims.
Section 1902(68) of the Social Security Act (SSA) promulgates the requirements of the Deficit Reduction Act (DRA) of 2005 which requires that, any entity receiving "annual payments under the State plan of at least $5,000,000, shall establish…" a written compliance plan. Healthcare corporations, regardless of their annual State reimbursements, are under media and government scrutiny when it comes to potential violations of compliance with Federal and State statutes, regulations and overall program requirements. Therefore, it is vital for most providers to establish and implement a corporate compliance plan. Moreover, proof of an effective compliance plan can substantially reduce a provider’s culpability when an issue arises and/or is investigated.
We can assist providers in drafting effective compliance plans. We also review existing compliance plans with a focus on Medicaid regulations and audit policies to determine whether the plan fulfills the necessary requirements.
Self-Disclosure Protocol Assistance
In 1998, the Office of Inspector General (OIG) issued a Federal Register notice regarding the Provider Self-Disclosure Protocol which offers healthcare entities the opportunity to voluntarily disclose Medicaid program abuse ranging from "simple errors to outright fraud." Our firm will assess whether the abuse identified warrants a Self-Disclosure and if so, we will assist in drafting the disclosure document specific to the provider’s potential violation of criminal, civil or administrative laws. The goal throughout the entire disclosure process is to achieve satisfactory resolution for the provider.
Corporate Integrity Agreements (CIA) Assistance
Our firm is able to assist healthcare providers in obtaining settlements with the Office of Inspector General (OIG) by negotiating and developing comprehensive integrity agreements that address provider specific obligations and emphasize the provider’s commitment to compliance with Federal health care program requirements by implementing and following a comprehensive compliance plan.
Director of Medicaid Audit Services
Click to view newsletters.