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Medicaid Audits in Illinois

Posted on in Healthcare License Defense IDFPR

Chicago medical license defense lawyerWhen one hears the word “audit,” it often triggers a negative reaction. After all, no one wants their financial life picked apart by the IRS. Being notified that your practice is going through a Medicaid audit can bring about the same type of reaction. Even if you feel there should be no issues with your practice, if the government finds any errors, it can lead to very expensive consequences and even have an impact on your medical license.

Notification of a Medicaid Audit

Approximately 25 percent of Illinois residents are covered under the state’s Medicaid program for their medical benefits. The Department of Healthcare and Family Services, Office of the Inspector General, Bureau of Medicaid Integrity is the state agency that oversees Medicaid audits. The goal of these audits is to prevent abuse, fraud, misconduct, and waste of the state’s Medicaid program. If any evidence of wrongdoing is found, those held responsible could face payment suspensions and even criminal charges, depending on the allegations.

When a practice has been selected for an audit, the physician will be notified by the OIG in writing that an audit is being conducted. Along with that written notification will usually be either a request for samples or a list of patients in the practice, along with a detailed questionnaire for each patient. During the audit process, there will typically be even more requests for information.

Response to a Medicaid Audit

It is critical for the practice to fill out and provide all the information that is being requested, including all medical records. There will only be a limited window of time to provide this information, so it is essential you are aware of any deadlines the OIG has imposed. Given the serious nature of these audits, having a qualified attorney guiding you through this complex process can make all the difference in the outcome of the audit.

In fact, one of the most important steps you can take during a Medicaid audit is to conduct a self-audit. Your attorney can review all the claims paid by Medicaid for the audited patients they are requesting to make sure there were no errors or inconsistencies that could be picked up by the OIG during their analysis of the records. Knowing ahead of time that there may be an issue with a patient’s record will enable you to have a valid explanation as to what occurred instead of being caught off-guard and potentially accused of wrongdoing.

Call a Chicago Professional License Attorney

If you have been notified that your practice is undergoing a Medicaid audit, contact a Chicago Medicaid audit lawyer today. Call Williams & Nickl, LLC at 312-335-9470 to schedule a free and confidential consultation.


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