Q & A

Saturday, May 31, 2003

Battling with overzealous auditors
MIAMI — When it comes to overzealous Medicare auditors, Healthcare attorney J. Everett Wilson isn’t sure if the problem stems from being overworked or from a lack of training. Whatever: “I’ll see investigators who will go out there and won’t know the regs that apply to a particular provider. And many times that will lead to misinterpretation and imposition of an overpayment.” If that’s the case, what’s an honest provider do to? For some insight, we asked Wilson, who is managing partner of the Miami law firm of Wilson, Suarez & Lopez

HME: Set out a typical scenario that shows how a HME provider may unknowingly run afoul of reimbursement regulations

Wilson: Say you have been providing a service for years. The patient needs it. You get a prescription all the time renewing the service. Then Medicare imposes a reg that says you have to get it reviewed every three months and nobody picks up on it. You think everything is fine, but several years down the road, you get audited and since you don’t have the documentation, you get hit with an overpayment. It’s your responsibility to know those regs.

HME: Sounds like that could happen to anyone.

Wilson: There are so many regs and changes in regs, and it’s hard to keep up. But if you have an active compliance review, if you have someone go in every six months and make sure your records are in compliance with reimbursement regs at that point in time, you can avoid most overpayments. HME