Payer Audits: Your Rights as an Agency

Description

Under Review: Navigating Audits in Home Health Care

Payer audits are becoming increasingly common across MassHealth, Managed Care Organizations (MCOs), Accountable Care Organizations (ACOs), and other payers — and for many providers, the process can feel overwhelming, adversarial, and high stakes.

This presentation will be focused on providing an understanding of audits in home health care by insurance companies and Medicare, including records requests, pre-payment reviews, post-payment reviews, and overpayment notices.  The presentation will also address what to do if you get audited and what can trigger an audit.   

Agencies will gain an understanding of the processes private payors and Medicare use to conduct audits, an understanding of their rights, and best practices.

Speakers: Jay McCormack, Partner, Verril; Annabel Rodriguez, Associate, Verrill Dana, LLP

Jay McCormack is a partner in the Boston office of Verrill where he is a member of the White-Collar Defense & Government Enforcement, and the Health Care & Life Sciences practice groups.  His practice focuses on the defense of a broad spectrum of investigations and criminal, civil and administrative enforcement proceedings. With significant experience in the health care sector, Jay defends matters involving the False Claims Act, Anti-Kickback Statute, Illegal prescribing and civil Controlled Substances Act violations. More broadly, he defends clients against various allegations of fraud, money laundering, export and trade controls, including customs fraud enforcement, and COVID-19 grant fraud (e.g., PPP and EIDL).

Jay joined Verrill after spending more than 15 years as a prosecutor at the local, state and federal levels.  Jay joined Verrill from DOJ, where he served for more than 6 years.  His DOJ service began as a Trial Attorney in the Health Care Fraud Unit in the Criminal Division’s Fraud Section in Washington, D.C., where he prosecuted health care fraud and other white collar violations across the country, and then served as the First Assistant United States Attorney in the District of New Hampshire, and more recently served as the Acting United States Attorney for the District of New Hampshire.

Annabel Rodriguez is an Associate at Verrill Dana, LLP and is a member of the Healthcare and White-Collar groups. She represents clients in all stages of litigation in federal and state courts, arbitrations and government investigations. Her practice focuses on government investigations, matters involving the False Claims Act, Anti-Kickback Statute, the Stark Law, the Racketeer Influenced and Corrupt Organizations (“RICO”) Act, and public corruption offenses.

Annabel is a graduate of Boston University and Suffolk University Law School. Upon graduation, she served first as a law clerk for Associate Justice Mary Thomas Sullivan at the Appeals Court, and then as a law clerk for the Honorable William Young of the United States District Court for the District of Massachusetts.