PYA Principal Denise Hall-Gaulin was recently quoted in “With Audits Up, SUD Providers Are Especially Vulnerable to Enforcement Actions.” A growing number of Americans are struggling with substance abuse disorders (SUDs) and mental health conditions. More lawmakers are taking notice, investing more attention and funding to fix the problem. With more funding comes a greater focus on compliance and enforcement. This Behavioral Health Business article explains the increase in audit activity, details ways mental healthcare providers can protect themselves from audits, and encourages providers to conduct internal audits and self-disclose any findings.
In the event a provider has already made a mistake in any one of those areas, it’s not too late to get ahead of the problem. For example, the federal government has a 60-day overpayment self-disclosure rule, which allows organizations to self-report overpayments and correct past claims in a certain time frame.
“You could go back a full year with Medicare, and if you say, ‘Oops, we did a bad thing, and we need to correct all the claims,’ you could correct them,” Hall-Gaulin said. “But anything past that, you have to essentially do a probe sampling and potentially a statistically valid sampling of what the problem is.”
Read the full article here.
If you would like more information about healthcare-related audits or would like assistance with any matter involving compliance, strategy and integration, or valuation, contact one of our PYA executives below at (800) 270-9629.