Healthcare Providers Facing DOL Audits Need to Defend Themselves Effectively
For healthcare providers that treat federal employees, reimbursements from the U.S. Department of Labor (DOL) can be a critical source of revenue. But, accepting payment from the DOL also opens healthcare providers up to scrutiny. The DOL regularly audits healthcare providers that bill for reimbursements, and these audits can present significant risks for providers that aren’t careful.
Put our highly experienced team on your side
Roger Bach
Former Special Agent (OIG)
Timothy E. Allen
Former Senior Special Agent U.S. Secret Service
Chris J. Quick
Former Special Agent (FBI & IRS-CI)
Maura Kelley
Former Special Agent (FBI)
Ray Yuen
Former Supervisory Special Agent (FBI)
Michael S. Koslow
Former Supervisory Special Agent (DOD-OIG)
Marquis D. Pickett
Special Agent U.S. Secret Service (ret.)
DOL Audits Present Significant Risks for Healthcare Providers that Treat Federal Employees
Similar to all other types of healthcare billing audits, DOL audits require a strategic and effective defense. Failing to defend against a DOL audit can lead not only to recoupment demands, but other consequences as well. If an audit uncovers significant overpayments, the DOL can deny pending claims and institute prepayment review, or it can simply exclude providers from billing for reimbursements in the future.
If the DOL’s billing auditors determine that a provider’s errors rise to the level of fraud, a DOL audit can also trigger a civil or criminal healthcare fraud investigation. The consequences of these inquiries can be even more severe—including substantial fines and prison time in some cases. As a result, healthcare providers cannot afford to take their DOL audits lightly, but instead must engage an experienced outside consulting firm to deal with the DOL on their behalf.
Our DOL Audit Defense Services are Backed By Centuries of Relevant Experience
At Corporate Investigation Consulting, we provide DOL audit defense services backed by centuries of relevant experience. Our team includes several former federal healthcare fraud investigators who spent decades examining providers’ billing records for the government before moving into the private sector. As a result of this experience, we are intimately familiar not only with the DOL billing rules, but also with how the DOL enforces these rules. We know the issues that can lead to problems for healthcare providers during DOL audits, and we know the strategies providers can use to overcome them.
What To Expect During a DOL Audit
When facing a DOL audit, it is important to know what to expect. This will allow you to make informed decisions, and it will allow you to proactively manage your practice’s risk so that you do not face unwarranted recoupment liability (or other consequences) unfairly or unnecessarily.
Here is what you can expect during your healthcare practice’s DOL audit:
- The DOL Will Conduct an Exhaustive Billing Review – DOL audits are comprehensive, exhaustive, and time-intensive endeavors. The DOL’s auditors will seek to scrutinize a substantial volume of your practice’s billing records, and you will need to be careful to ensure that only billings that are eligible for review get reviewed.
- The DOL Will Expect to See Proof of Compliance – Beyond examining your practice’s billing records, the DOL will also want to see your practice’s compliance documentation. If you do not have the documentation needed to prove compliance, this will create significant challenges during the DOL audit process.
- Lack of Proof Will Be Deemed Evidence of Noncompliance – If you are unable to prove compliance, this will be deemed evidence of noncompliance. This is one of several reasons why healthcare providers cannot ignore the audit process. Providers must be prepared to affirmatively demonstrate compliance, and they must be able to demonstrate compliance effectively in order to avoid unnecessary consequences.
- The DOL’s Auditors Might Make Mistakes – When auditing your practice’s billing records, the DOL’s auditors might make mistakes. This is another reason for providers to play an active role in their DOL audits. If auditors incorrectly calculate the reimbursements your practice was entitled to receive, this could lead to unjustified recoupment demands.
- The DOL’s Auditors Will Seek to Impose Recoupment Liability – The purpose of a DOL audit is to uncover overpayments; and, to show that their efforts are worthwhile, auditors will seek to impose recoupment liability—unless you intervene. As a result, healthcare providers cannot take a passive approach, but must instead focus on executing a proactive defense.
- The DOL’s Auditors May Impose Other Penalties As Well – Along with recoupments, DOL audits can also lead to various other penalties. These include denial of pending claims, prepayment review, and exclusion as noted above. If DOL auditors uncover what they determine to be evidence of intentional billing fraud, they will not hesitate to hand this evidence over to the U.S. Department of Justice (DOJ) for use in a subsequent civil or criminal prosecution.
- You May or May Not Know Why the DOL Reached Its Decision – The DOL audit process can be surprisingly, and unnervingly, opaque. As a result, if auditors impose recoupments or other penalties, you won’t necessarily know why. But, you can avoid this by engaging an outside consulting firm to take control of the process for you.
Why Healthcare Providers Nationwide Choose Us for DOL Audit Defense
When facing a DOL audit, engaging an outside consulting firm is essential for mitigating the risks involved. Here are just some of the reasons why healthcare providers nationwide choose Corporate Investigation Consulting for DOL audit defense:
- We Are a Team of Former Federal Healthcare Fraud Investigators – Several of the members of our DOL audit defense team spent decades investigating healthcare billing fraud for the federal government before joining our firm. As a result, we know how to examine DOL billings from the government’s perspective.
- We Know the DOL Billing Rules Inside and Out – Our extensive experience also means that we know the DOL billing rules inside and out. Unlike consultants at other firms, our experts do not need time to get up to speed.
- We Conduct Comprehensive Internal Billing Reviews to Assess Our Clients’ Risks – One of our first steps with every engagement is to conduct a comprehensive internal billing review. This lets us know where our clients’ risks lie and formulate our defense strategy accordingly.
- We Work Proactively and Strategically to Protect Our Clients – Our goal in every engagement is to protect our client as quickly, quietly, and cost-effectively as possible. This means taking a proactive and strategic approach to dealing with the DOL’s auditors during the audit process.
- We Execute Custom–Tailored Defense Strategies – We don’t take a one-size-fits-all approach to DOL audit defense—because this approach simply doesn’t work. Instead, we develop and execute custom-tailored defense strategies based on our clients’ specific risks and opportunities.
- We Do Not Hesitate to Question the DOL’s Practices When Necessary – When the DOL’s auditors make mistakes, we let them know. We do not hesitate to question the DOL’s practices, and we make sure that mistakes and overreaching do not lead to unwarranted consequences.
- We Have a Proven Record of Success in DOL Audits – Finally, and perhaps most importantly, we have a proven record of success in DOL audits. We have helped healthcare providers across the country not only avoid substantial recoupment liability, but also avoid other penalties and the risk of civil or criminal prosecution.
FAQs: What Healthcare Providers Need to Know About DOL Audit Defense
What Should I Do if the DOL is Auditing My Healthcare Practice?
If the DOL is auditing your healthcare practice, you should engage a consulting firm promptly. You will need to defend against the audit effectively to avoid unnecessary recoupment liability and other penalties, and this requires a comprehensive understanding of both the DOL billing regulations and the DOL’s auditing procedures.
Should I Engage a Consulting Firm for DOL Audit Defense?
Yes, engaging a consulting firm is the best way to protect your practice (and yourself) during a DOL audit. But, it is important to choose wisely. Not all consulting firms offer the same capabilities, and you should choose a firm with former federal healthcare fraud investigators who know what the government is looking for when scrutinizing providers’ billing records.
How Can I Avoid Recoupments During a DOL Audit?
Avoiding recoupments during a DOL audit requires proof of billing compliance. Providers need to have documentation on hand which shows not only that they have billing compliance procedures in place, but also that these procedures are working effectively to prevent DOL billing fraud.
What if I Know My DOL Billings Aren’t Accurate?
If you know that your practice’s DOL billings are not accurate, this is something you will need to address proactively—but also very carefully. Our consultants have assisted numerous healthcare providers in this situation, and we can use our experience and insights to help protect you.
What Are My Options if I Disagree with the Results of a DOL Audit?
If you disagree with the results of a DOL audit, you will need to explore your options for filing an appeal. But, it is far better to avoid an unfavorable final result (and the need to pursue an appeal) if possible. At Corporate Investigation Consulting, we work with the DOL’s auditors on behalf of our clients to resolve our clients’ audits as favorably as possible.
Request a Complimentary DOL Audit Defense Consultation Today
If you would like to know more about our DOL audit defense services for healthcare providers, please contact us to arrange a complimentary initial consultation. To discuss your practice’s needs with a senior DOL audit defense consultant at Corporate Investigation Consulting in confidence, please call 888-352-9324 or tell us how we can help online now.