Healthcare Audits and Investigations in Illinois

 Posted on October 11, 2021 in Medical License Defense

Hearing the word “audit” can trigger a stressful reaction, no matter what entity is conducting the audit. One of those entities is the Illinois Office of Inspector General. Receiving notification that your medical practice is under an audit or investigation by IG could result in severe consequences without the experienced and skilled representation of an Illinois medical license defense attorney.

Is There a Difference Between a Healthcare Audit and a Healthcare Investigation?

The two terms are often misunderstood to mean the same thing but there are specific differences between the two. A healthcare audit examines the behaviors and actions of the medical practice when it comes to the financial side of things. An audit will examine what the practice is issuing charges for, how funds are being spent, and if there is cohesiveness with all of these figures.

There are several reasons why a healthcare audit may be initiated. One of the most common issues that can trigger an audit is when an insurance provider makes a claim that the practice is overcharging for the services and care they provide. The insurance company may not accuse the practice of outright fraud, however, just that inquiry triggers an audit in order to provide the insurance company with the answers that justify the practice’s fees and charges.

There may also be an audit triggered to examine the different products, services, and equipment that the practice purchases because of questions of the legitimacy of the purchases.

A healthcare investigation also examines how the medical practice is charging patients or spending money; however, an investigation is initiated when there is cause to believe that fraud or some other illegal activity has been occurring. An investigation can be triggered because of suspicious billing patterns by the practice, or a patient or insurance company thinks they were intentionally billed too much. An investigation may also be initiated due to evidence of fraud uncovered in an audit. Lastly, there are also investigations that begin because an employee of the medical practice reported the fraud or wrongdoing to the board or a law enforcement agency.

Should You Hire an Illinois License Defense Attorney?

Whether you have been informed your practice is under an audit or an investigation, it is in your medical practice’s best interest to not attempt to respond to these actions on your own and without the guidance and legal expertise of an experienced Illinois medical practice defense lawyer. Contact The Law Offices of Joseph J. Bogdan, Inc. at 630-310-1267 to schedule a free consultation to find out what legal options you may have to protect your medical practice from potential action by the Office of Inspector General.

Source:

https://www2.illinois.gov/hfs/oig/Pages/Welcome.aspx