What is a Medicaid Audit and How Can You Prepare?

Like many other types of business, businesses that handle Medicaid claims are likely to be audited. Preparing properly for these audits ahead of time will minimize the disruption they cause. Here’s what you need to know to prepare properly for a Medicaid audit.

How Likely Is a Medicaid Audit?

There is a very good chance that any business participating in Medicaid is likely to be audited. Healthcare fraud is a severe issue in the United States; the US government ends up paying billions every year in fraudulent claims, and the most effective tool at their disposal for preventing Medicaid fraud is regular auditing. These audits enable the government to identify any healthcare providers who are playing fast and loose with the system. Levying severe financial penalties against unscrupulous actors serves as an effective deterrent for other people who might otherwise try to game the system.

Every business that partakes in the Medicaid system needs to be prepared for an audit at any time. The best way of preparing for audits is to keep your Healthcare business as organized as possible in general. Provided that all of your paperwork and other admin is in order, you have nothing to fear should the auditors arrive.

What’s the Best Way of Preparing?

This article about Medicaid Audit How To Avoid Criminal Charges from Healthcare Fraud Group Llc is the perfect starting point for any business concerned about their preparedness for a Medicaid audit. As the article states, “the offense is the best defense” against a Medicaid audit.

You should always try to be proactive as far as regulators and auditors are concerned. Don’t wait for them to highlight deficiencies in your business. Instead, make every effort to root out these issues beforehand and fix them before the auditors discover them. 

It is advisable to institute a Medicaid compliance program within your business. This program should ensure that everyone within your organization who handles Medicaid-related claims understands how to file them correctly and how to ensure that they are dealt with according to the SSA’s expectations.

ZPIC Audits

There are numerous reasons why Medicaid might intervene directly in the affairs of service providers. There are also various legal routes that Medicaid can take to deal with service providers who are acting fraudulently. The ZPIC audit is the most serious of these. ZPIC is short for Zone Program Integrity Contractor. This is the name given to the handful of private businesses that handle audits for Medicaid.

Unlike most Medicaid audits, ZPIC audits are not random. This type of audit usually starts when there is already some indication of wrongdoing within the target entity. If a Medicaid supplier is located within a ‘high risk’ area, the chances of being audited are even higher.

Any business that is liable to be the subject of a Medicaid audit should understand exactly what is involved and how they can prepare for it. As long as you have reasonable procedures in place for handling Medicaid claims, you should have no trouble staying on the right side of the regulations.