Our Firm is aptly positioned to provide complete support for Medicaid providers, including hospitals, in navigating through the arduous Medicaid audit process.

We assist clients with their Department of Social Services Medicaid Audit process through:

Educational Seminars
We will assist your organization with understanding the Medicaid audit process and how proper billing, coding and documentation procedures and practices can help reduce your audit exposure.

Periodic Record Reviews
We replicate an actual Medicaid audit to determine your organization’s compliance weaknesses. These mock audits could save you from costly financial disallowances and extrapolated audit adjustments. Using the results of our audit, we can 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
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
We will represent your organization throughout the entire 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.

We are also able to assist your organization, even before the audit process, through our compliance review services. Our Firm assists providers in improving their Medicaid compliance programs through:

  1. Performing a comprehensive review of Medicaid billings and corresponding clinical documentation to minimize future risks of non-compliance with DSS policy and documentation requirements.
  2. Assisting clients in drafting effective compliance plans.
  3. Reviewing existing compliance plans with a focus on Medicaid regulations and audit policies to determine whether the plan fulfills the necessary requirements.
  4. Conducting Medicaid compliance and audit educational seminars.

Attorneys in this Practice Area:

Robert D. Tobin

Robert D. Tobin

Commercial Litigation, Gaming Law, Real Estate Transactions, Medicaid Revenue Recovery, Medicaid Audit & Compliance and Workers’ Compensation Revenue Recovery

Jerry O'Malley

F. Jerome O’Malley

Personal Injury & Wrongful Death, Criminal Defense, Alternative Dispute Resolution, Liquor Licensing, Gaming Law and Medicaid Audit & Compliance

Joseph J. Selinger

Joseph J. Selinger

Public Finance, Corporate Finance & Securities, Business Organizations, Real Estate Transactions, Medicaid Audit & Compliance

Staff in this Practice Area:

Jim Wietrak

James Wietrak

Medicaid Audit & Compliance

Denise Smith

Denise L. Smith

Medicaid Audit & Compliance