With So Much at Stake, Physicians and Other Health Care Providers Shouldn’t Take an Audit Letter Lightly

Receiving an audit letter or any request for information from the government can be intimidating and confusing. The first and most important step is to read the audit letter thoroughly. It is important to determine which government entity is requesting the information.

Centers for Medicare and Medicaid Services (CMS) uses a balanced approach to prevent improper payments and to identify and recoup improper payments that have already been issued. Several government agencies and government contractors are tasked with health care fraud detection and prevention.

Each government agency attacks health care fraud through a different avenue. Some government agencies simply ask for additional information or documentation for specific claims. Sometimes, government agencies or contractors will identify a certain area of risk within a medical specialty or procedure and will conduct “spot checks” of random samples of claims. Other agencies will conduct audits and investigations when there is a suspicion of health care fraud by a specific health care provider.