The HART of the NCMS - Healthcare Audit Resource Team

More than ever before, Medicare and Medicaid officials and contractors are looking to physicians and medical practices to recover funds for those programs. Given the increase in audit activity around North Carolina and the Patient Protection and Affordable Care Act's strong emphasis on fighting healthcare fraud and abuse, the NCMS convened the Healthcare Audit Resource Team to identify tools that will help physicians and practice staff avoid government audits through best practices and provide helpful guidance once a practice has been contacted by an auditor.

Many of the resources on this page were provided by Team members. Each of these talented individuals has considerable experience working with physicians and other providers on issues relating to fraud and abuse and are highly regarded in the industry.

Team Contributors

Chris Brewer | Mike Gordon | Rose Shattuck | Franklin Walker | Conor Brockett

General Audit Information NEW! Medical Audits: What Physicians Need to Know - Physicians Advocacy Institute (PDF) NC DMA Proceeds with Medicaid RAC Program Directory of Audit Contractors - Conor Brockett, NCMS What to Do when the Government Comes Knocking - By Michael R. Gordon of K&L Gates LLP (PDF) I Think I'm Being Audited! What Should I Do Now? Rose Shattuck, Shattuck Consulting (PDF) Medicare Audits Outlines of Appeals Process Health Care Provider Reimbursement: Compliance & Enforcement - Chris Brewer, Poyner-Spruill (PDF - 20 pages) North Carolina RAC & ZPIC Issues: Medicare Claims Appeal Processes Sean Timmons and Frederick Zufelt, Smith Anderson Medicare Appeals Process - Brochure created by the Medicare Learning Network (CMS) Helpful Links CMS Palmetto GBA Connolly AdvanceMed Medicaid Audits Overview Program Integrity: Current Fraud & Abuse Initiatives in North Carolina NC Division of Medical Assistance (PDF - 21 pages) New NC Medicaid Fraud and Abuse Law The Veto Override You Didn't Hear About: SB 496 – Medicaid Provider Fraud & Abuse - Conor Brockett, NCMS Summary of SB 496 – Medicaid Provider Fraud & Abuse Curtis Venable, Attorney with Ott Cone & Redpath, P.A. (PDF - 7 pages) SB 496 - Medicaid Provider Fraud & Abuse law (PDF - 12 pages) Helpful Links NC Division of Medical Assistance (NC DMA) Fraud and Abuse Overview Reporting Fraud and Abuse NC Department of Justice Overview of the Attorney General's Medicaid Investigations Unit (MIU) Reporting Medicaid Fraud and Abuse

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