Medical Audits and Fraud Investigations

Our law firm represents physicians and healthcare businesses who are the subject of medical audits. There are many types of medical audits that can potentially have very significant adverse financial consequences for healthcare providers, including:

  • Third Party Payer Medical Audits
  • Fraud and Abuse Investigations
  • Recovery Audit Contractor (RAC) audits
  • Medicare Administrative Contractors (MACs)
  • Medicare Integrity Contractors (MICs)
  • Medicaid RACs
  • Zone Program Integrity Contractors (ZPICs)
  • Office for Civil Rights (OCR) audit program for HIPAA compliance
  • Office of Pharmacy Affairs Section 340B Audits
  • Drug Manufacturer Section 340B Audits

The focus of our Atlanta and Augusta healthcare law firm is representation of healthcare providers and professionals. Our objective is to protect healthcare providers and professionals; helping them make more money and sleep better.

Georgia and South Carolina Business and Healthcare Law Firm

Our law firm is committed to protecting the financial interests of doctors and healthcare businesses in Georgia and South Carolina.

“Kevin Little [of Hamil Little] represented the Medical Association of Georgia and individual physicians in a matter addressing the abuses of the health insurance industry. Kevin was a pleasure to work with and brought forth legal theories to hold the health insurance industry accountable to physicians and patients. We received outstanding representation from Kevin.” *

Donald Palmisano, CEO and General Counsel, Medical Association of Georgia.

Our Country’s third party payer system, with federal and state governments as primary payers for healthcare services, has resulted in onerous regulation and heavy oversight of healthcare. One of the biggest examples and a major challenge for healthcare providers is medical audits.

There is growing pressure on government and private payers to control healthcare costs. That pressure causes many payers to find creative ways to use financially incentivized auditors to identify alleged overpayments or errors to obtain financial recoveries from healthcare providers. Every physician and healthcare business should be prepared for medical audits.

It Saves Money to Be Proactive

Involved medical audits can be expensive to defend and result in serious adverse financial consequences. While there is no guaranteed way to prevent a medical audit, being prepared for an audit will minimize risks and save money. The following steps for healthcare providers may reduce risks associated with medical audits:

  1. Self-Assess. Assess the risk of your medical practice or healthcare business to being subject to one of the various types of medical audits. Do not wait until you receive notice of some sort of medical audit.
  2. Hire a Consultant. There are many qualified consultants and experts who can sample billing and medical records, identify problem areas, extrapolate patterns, and offer proposals to mitigate your risks. In fact, just the act of hiring a qualified healthcare consultant helps demonstrate good faith and an intention to follow the law.
  3. Respond Timely. If your healthcare practice or business receives an audit notice from a government entity or private payer, make sure that it immediately goes to the proper person in your business designated to receive such information. In virtually every instance, critical deadlines should be calendared for a response and steps immediately taken to begin the process of an internal review of the allegations and preparation for a time response.
  4. Hire Counsel. If it is a civil audit, realistically assess your risk of an adverse finding and the potential financial consequences. If the risk and money at stake are significant, hire qualified legal counsel immediately. If the audit is criminal, hire qualified legal counsel immediately and do not communicate with government personnel other than through your attorney.
We Protect Healthcare Providers

We protect and advance the financial interests of healthcare providers. Our attorneys have extensive experience and Martindale Hubbell has given our firm its AV-rating, the highest possible rating, for over ten years. Our law firm maintains offices in Atlanta and Augusta, Georgia. Our attorneys are active members of the American Health Lawyers Association and are licensed to practice law in Georgia and South Carolina. Call us at (404) 685-1662 (Atlanta) or (706) 722-7886 (Augusta and Aiken) to schedule a confidential consultation.

* DISCLAIMER: Any result this law firm or any lawyer of this law firm may achieve on behalf of one client in one matter does not necessarily indicate similar results can be obtained for other clients.