(August 28, 2012): 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 Miami, FL:
Miami Population: 408,750 (2011 Census)
Medicare Administrative Contractor (MAC) (Parts A/B): First Coast Service Options, Inc.
DME MAC (Region C): CIGNA Government Services Administrators LLC
Zone Program Integrity Contractor (ZPIC): Safeguard Services
Recovery Audit Contractor (RAC): Connolly Consulting Associates, Inc.
Medicaid Contractor: HP Enterprise Services
State Healthcare Investigative Service: Florida Agency for Health Care Administration (AHCA) Office of Inspector General (OIG)
Medicare Audits and Fraud Enforcement in Miami, FL:
Medicare’s fraud enforcement in Florida (and especially in Miami and the surrounding areas), have consistently remained a focus of the government’s investigation and prosecution efforts. Long considered the “epicenter” of healthcare fraud, the federal government has actively pursued administrative, civil, and criminal cases throughout the region. While at times this activity may appear to be unstoppable, it is important to keep in mind that the Miami area and surrounding townships have a disproportionately high number of Medicare eligible individuals. Is the which occurs in this area actually be proportional to that which occurs in the rest of the country? Regardless of the answer, it is important that ALL health care providers ensure that their activities fully comply with Medicare’s participation, coverage, coding and billing rules. Compliance is not an option — it is mandatory, regardless of your payor mix. Do you have an effective Compliance Plan in place? Have you recently conducted a review of your business, treatment and billing activities to better ensure compliance? If not, a comprehensive review should be conducted and any deficiencies must be immediately remedied.
Medicare contractors, including RACs and ZPICs, frequently audit providers in Miami and other cities in Florida, including Orlando, Fort Lauderdale, and Tampa Bay. If you receive a letter indicating you are being audited or investigated, it is important to seek the advice of counsel quickly, as these letters usually set out deadlines by which you must respond.
As a final point, if you are audited by a ZPIC, RAC, or a federal or state law enforcement agency, we recommend that you retain experienced and qualified legal counsel to assist in responding to an audit. Qualified legal counsel at your side can help ensure that all of your rights are preserved and that your responses and obligations to the government are timely and adequately met.
David Parker represents providers in Medicare post-payment audits and appeals, and similar appeals under Medicaid. In addition, David 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 David today at 1 (800) 475-1906.