Bass, Berry & Sims attorneys Anna Grizzle and Lauren Gaffney co-authored an article published in the July-August 2022 issue of the Journal of Health Care Compliance discussing understanding and responding to the CMS audit contractor enforcement landscape.
As Anna and Lauren point out, healthcare fraud enforcement continues to generate a significant amount of attention due to the large recoveries announced each year by the Department of Justice (DOJ) with $5.6 billion recovered in settlements and judgments in FY 2021 from civil cases involving fraud and false claims. While healthcare companies should take steps to avoid the pitfalls leading to these settlements and judgments, DOJ actions are not the only enforcement threat. Claims audits by government contractors are increasing and adverse audits can often come with significant consequences, such as large overpayment demands and payment suspensions. This article explains how to response to these audits and the steps providers can take to ensure appropriate coding and billing.
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