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How Do Penalties Exceed $100,000

 

Extrapolation!

Many doctors do not believe the high audit penalties.  Until they are audited.

    

Typical penalties range from $150,000 to over $225,000!

Every week we are ask to help practices with penalties over $1,000,000!

  

One doctor who was audited asked "They found $20,000.  How did this become $245,000!"

The answer is Extrapolation!

   This is serious!

We are frequently asked how they can penalize those high amounts.  Here is what occurs.

   

  • Before an audit is scheduled, the insurance auditors review claims you previously submitted. 

  • Based on this review, they target "suspect" claims.  Claims they believe will fail.

  • Those are the records they request. 

  • This provides the auditor with what they want; a higher probability of you losing an audit.

  • It provides them with a higher percentage of failures. 

  • They apply that percentage to all the claims you submitted for multiple years!  This is "extrapolation

  • Resulting in a high penalty.  More money you have to pay them!

   

This is an actual audit penalty calculation for a practice!

Records Reviewed
Records Failed 
% of Records Failed 

Total Reimbursement  2011 2016   
Failed % of Total Reimbursement     
Interest and Penalties                        
Total Due by Practice 
45
41
91%

$127,569
$116,087
  $79,695
$195,782

This is a real case!  That is how the penalties exceed $100,000!

   

Contact Nteon Practice Consultants to Protect You and Your Practice!