Georgia's Trusted Healthcare
& Medical Provider Attorneys

Healthcare Providers Could See an Increase in Centers for Medicare and Medicaid Services Audits

On June 2012, the Department of Justice (DOJ) issued a report from its study of Home and Community Based Services (HCBS) waiver programs.  Seven of 25 states reviewed were found to have systems that were lacking in their ability to provide quality care to waiver program recipients.  In addition, the study found that the Centers for Medicare and Medicaid Services (CMS) did not use all means available to monitor the states’ programs.  As a result, the DOJ recommended that CMS implement additional requirements to ensure quality care.

Going forward, states may see more involvement and oversight on the part of CMS in enforcing compliance with the requirements of the HCBS waiver programs.  The increased attention paid by CMS could mean more site visits, audits, and compliance initiatives aimed at providers.  As with any audit or proposed adverse action, it is always to the provider’s benefit to consult with an experienced healthcare attorney immediately upon receipt of notice of an upcoming audit, audit results or overpayment demand letters.  The attorneys at Jeyaram & Associates have in-depth audit experience and are available for consultation.