MIC Audits and Overpayment Appeals Medicaid audit and overpayment appeal attorneys

Through the Deficit Reduction Act (DRA) of 2005 the Centers for Medicare & Medicaid Services (CMS) developed the Medicaid Integrity Program (MIP) to identify, recover and prevent inappropriate Medicaid payments. The MIP supports the efforts of State Medicaid agencies through a combination of oversight and technical assistance. The MIP is CMS’s first national strategy to detect and prevent Medicaid fraud and abuse. Under the leadership of the Center for Medicaid & State Operations (CMSO), the agency has designed a program to combat fraud, waste, and abuse in Medicaid.

Gaitan Law Group represents Medicaid providers and suppliers from the moment they receive the first audit notice, through the conclusion of the appeal process.  We help our clients understand the scope of the appeal and prepare for the legal and financial challenges that are usually accompany a Medicaid program audit.

The MIP requires CMS to utilize Medicaid Integrity Contractors (MICs) to:

(a) review the actions of those seeking payment from State Medicaid plans;

(b) audit Medicaid claims;

(c) identify overpayments related to those claims; and

(d) educate providers and others with respect to payment integrity and quality of care.

It is important for a Medicaid provider or supplier to understand the role of the MIC.  Most importantly, every Medicaid provider and supplier should be aware that the  MIC has the authority to make an overpayment determination requiring the provider or supplier reimburse the Medicaid program, for reasons such as: improper billing codes; non-covered services; Medicaid services were not provided or properly documented; Medicaid payments were not in accordance with federal or State law; and failure to comply with federal or state Medicaid program requirements.  Similarly, the audit MIC can also make fraud referrals to HHS OIG.

At , our attorneys work with Medicaid providers and suppliers to prepare and respond to MIC audits.  Our clients benefit from the firm’s lawyers ability to aggressively confront reimbursement and compliance issues throughout complex administrative procedures and subsequent judicial proceedings.   Our attorneys work with Medicaid participating physicians, providers, suppliers and others to develop an internal procedure for responding to MIC documentation requests and to identify and limit the scope of the audit.  Our lawyers are dedicated to establishing proactive relationships with clients, aligning themselves with clients to develop an integrated responsive strategy for responding to the initial MIC notice letter; entry conferences; record requests; responding to the draft audit letter; reviewing and challenging the validity of statistical sampling; appealing overpayment determinations before AHCA, and the DOAH; and appealing cases to Florida state courts. 

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