UPIC Audits, ZPIC Audits, Medicaid Audits, Private Payor Audits, Medicare Suspensions, Revocations Actions, State Licensure Board Actions

Medicare Audits in Baton Rouge, LA

In this  feature, we focus on particular Medicare audits and appeals information for various ZPIC audit and RAC audit hotspots around the country. Check back in for information about Medicare audits and appeals in your city.

Medicare Audits in Baton Rouge, LA

At-a-Glance Information:

Baton Rouge Population: 230,139 (2011 Census)
Medicare Administrative Contractor (MAC) (Parts A/B): Novitas Solutions LLC (a/k/a Highmark)
DME MAC (Region C): CIGNA Government Services Administrators LLC
Zone Program Integrity Contractor (ZPIC): AdvanceMed Corporation
Recovery Audit Contractor (RAC):  Connolly Consulting Associates, Inc.
Medicaid Contractor: Molina Medicaid Solutions and Bayou Health provide Medicaid claims processing services; no Medicaid Recovery Audit Contractor has been selected yet
State Healthcare Investigative Service: State of Louisiana Department of Health & Hospitals

Medicare Audits and Enforcement in Baton Rouge, LA

Medicare Audits in Baton Rouge, LA

Baton Rouge, LA Skyline (courtesy southeastBR)

Baton Rouge, the capital of Louisiana and home to LSU, has recently seen a major uptick in Medicare and Medicaid fraud, particularly in the mental health field. In fact, the Office of Inspector General’s (OIG) and the Department of Justice’s (DOJ) joint HEAT teams have engaged in multiple actions in the area. As a result, the Zone Program Integrity Contractor (ZPIC) for the region, AdvanceMed, has initiated a multitude of actions in Baton Rouge.

AdvanceMed has been a leading ZPIC for many years. When the Program Safeguard Contractor (PSC) program was active, AdvanceMed held the contract for that role as well. As a ZPIC, AdvanceMed has only expanded the number of contracts it has, now performed fraud, waste, and abuse auditing in over half the country. Particularly after the devastation of Hurricane Katrina, AdvanceMed was quick to audit a variety of providers, including psychiatrists, community mental health centers, E/M physicians, and home health agencies – many of whom were doing “heavy lifting” in treating the disabled and elderly in the wake of the Katrina disaster. While AdvanceMed has denied a number of claims supported by records lost in Hurricane Katrina, we have successfully argued for an emergency waiver of such documentation during hearings before an Administrative Law Judge (ALJ).

In any regard, whether a ZPIC, RAC, or a federal or state law enforcement agency is involved, providers in Baton Rouge, LA should be sure to retain experienced and qualified legal counsel to assist them with Medicare audits and appeals. Having qualified legal counsel by your side can ensure that all of your rights are preserved and that your responsibilities to the government are timely and adequately met.

Robert LilesRobert Liles represents providers in Medicare post-payment audits and appeals, and similar appeals under Medicaid. In addition, Robert counsels clients on regulatory compliance issues, performs gap analyses and internal reviews, and trains healthcare professionals on various legal issues. For a free consultation, call Robert today at 1-800-475-1906.

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  1. […] discussed some of the Medicaid contractors for various “hot-spot” cities, such as Baton Rouge and Houston, and you might find it interesting to note that a lot of Medicaid claims processing […]

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