In reality, very few doctors are guilty of out-and-out fraud. Far more often, problems arise from more innocent scenarios.
“Part of it is carelessness, lack of attention to details on the part of the doctors,” says Hertz. “Other physicians really just have a lack of understanding of the coding and documentation principles.”
Be Fast and Proactive
To ensure you satisfy CMS’s request in the quickest and most efficient manner possible, Hertz suggests turning the matter over to a specific point person in your office. That person should put a plan together for handling the audit and make it his top priority. And don’t take too long to perform your internal review; most auditors ask to have copies of the requested records in hand within 10 to 20 days of giving notice.
Communicate openly with the government from the moment you receive a letter announcing an audit, advises Sara Kay Wheeler, a healthcare attorney based in Atlanta. “Be really proactive,” she says. “Ask lots of questions. Get lots of details. Talk to the auditor about what is expected. The more open the attitude of the physician in working with the auditor, the better the audit will go.”
Glaser adds that when you call CMS for questions or advice during this process, it’s a good idea to write down everything said during the conversation — in specific and exact detail — and then send a copy of your notes to CMS via certified letter. That makes it difficult for them to deny that the conversation ever took place.
Wheeler says it also doesn’t hurt to mention in those conversations that you have an attorney and she is assisting you with this matter: “This lets the auditor know that the practice is protected.”
Walk the Line
Be accommodating with auditors when they come knocking — but within reason.
“The true art in cooperating with auditors is in not bending too far backward,” says Wheeler. “Just give them exactly what they are asking for and no more. Otherwise you may expose more problems than need be, causing the auditors to look at more than they — and you — had anticipated.”
Just as altering your records before sending them to CMS is a giant no-no, so is coaching your employees on what to say to auditors, says Glaser. “The bottom line is, don’t sit down and discuss it with employees,” he advises. “If, the night before auditors plan to visit, you sit down with everyone to make sure you have your stories straight, the government views that as conspiracy to lie to a federal official.”
Anything you say to employees without an attorney present is discoverable. However, you can tell your employees what their rights are should an OIG investigator show up at their home to ask questions — which is not uncommon. “You can let them know that they don’t have to speak to the investigator, and if they do, they can have a lawyer present,” Glaser says.
He also points out there are cases in which investigators have told practice employees not to tell their physician bosses that the investigator contacted them. Glaser says it’s important to let your employees know it’s perfectly legal to let you know if a government official contacts them.
The Waiting Game
You’ve sent CMS copies of the records they requested. They’ve had them for weeks now, and no one is calling to let you know the status of your audit. What do you do?
