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How Do Penalties Exceed $100,000

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

    

Prior to last year, we found penalties ranged between $100,000 and $200,000.

In just this past year, we have seen penalties increase to more than $150,000 with several exceeding $225,000!

    

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 a number of claims you have submitted. 

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

  • Those are the records they request to review. 

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

  • It also provides them with a higher percentage of failures of exams. 

  • Finally, this provides them with a higher penalty.  More money you have to pay them!

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

   

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

Contact Nteon Practice Consultants to Protect You and Your Practice!