Carrie Valiant, a Member of the Firm in the Health Care and Life Sciences practice in the Washington, DC office, was quoted in an article titled "Alleged Tampering with Medical Records During Audit Leads to CMP Settlement."
Following is an excerpt:
Playing games with audits is risky business, as an unusual enforcement action by the HHS Office of Inspector General shows. In a July 26 civil money penalty settlement, Bravo Health of Pennsylvania, a Medicare Advantage plan, agreed to pay $225,000 over allegations that it falsified records submitted during an OIG audit.
More administrative and enforcement actions are sprouting from audits, says Washington, D.C., attorney Carrie Valiant, with Epstein Becker & Green, who was not involved in the Bravo case. "It's often the case that in government audits and investigations, the liability can come out of how you dealt with the audit and not the underlying substance," she says. "Once the government has knocked [on your door] in any capacity, it's really important to be above board, transparent and straight because it's one thing if there is an audit finding of an overpayment, but another thing entirely if the matter gets referred to the OIG or DOJ for false statements, where the penalties can be far worse."
Valiant suggests that providers and plans do mock audits so they are prepared for the questions they might be asked and review the documentation they may have to produce. The government's next move may depend on "how documentation was produced, how people came off in interviews or audit results that showed bigger underlying problems," she says.
