Legal
Oberheiden PC Outlines Provider Response Strategy for CMS Audit Notices
In a law firm client alert, Oberheiden PC attorneys explain how healthcare providers should respond to audit notices from CMS contractors covering Medicare and Medicaid billing. The piece describes several CMS contractor audit types, including CERT, MAC, RAC, UPIC, SMRC, and TPE audits, along with HHS OIG audits, and notes each carries distinct risks such as recoupments, payment suspensions, and criminal referrals. It states that even providers who fully complied with billing rules can face liability if they cannot affirmatively document that compliance, and that audits are often already underway by the time a provider receives notice.
Why it mattersMedicaid and Medicare providers facing a contractor audit notice may need to quickly identify the audit type and assemble documentation to avoid recoupment, exclusion, or referral for further investigation.