Friday, February 28, 2003

Q. What are the “realities” for HME suppliers who are subject to retrospective Medicaid audits?

A. There are at least two crucial “realities” for HME suppliers subject to Medicaid audits: (1) If auditors can show that suppliers either knew about or should have known about a pattern of conduct, the audit results may have serious consequences. Saying “I didn’t know” or having good intentions are not enough. In other words, suppliers have an obligation to be vigilant - to check up or monitor on a regular basis to make certain that applicable requirements are being met so there is nothing that they should have known about, but did not. (2) State budgets in many states are running at huge deficits. One of the biggest items in many of these deficit budgets is spending for Medicaid. Regulators are attempting to slow the flow of red ink by recouping as much money as possible retrospectively from providers. This means that retrospective audits and recoupments are very attractive to regulators and, since the need is so great, may be more difficult than usual for providers to resolve reasonably. From a “big picture” point of view, therefore, suppliers must do everything they can to make sure their noses are clean. One of the best ways to help ensure this result is to implement and/or properly maintain fraud and abuse corporate compliance plans. Corporate compliance plans are also likely to ease the burden on providers when audits lead to allegations of fraud and/or abuse.

Attorney Elizabeth Hogue is in private practice. Reach her at (301) 421-0134.