Your practice is the subject of a government audit. Now what? Audits and investigations are a fact of life for medical groups, but few leaders are fully prepared when the notice comes. Medicare, Medicaid, and commercial payers are expanding oversight, and even small coding errors, documentation gaps, or compliance missteps can quickly escalate into serious risk. The impact goes far beyond dollars. Financial penalties are significant, but reputational harm, regulatory scrutiny, and loss of trust can be just as damaging. How you respond — and how quickly you engage the right support — often determines whether the outcome is manageable or catastrophic. This session offers a candid discussion of the hard truths and critical lessons in responding to coding and regulatory issues. Attendees will gain insight into the types of audits most common in fee-for-service and government payment programs, the risks associated with each, and what investigators are really looking for. Participants will walk through a vignette that traces the response to an audit notice — from initial letter through risk mitigation — to help leaders be better prepared. In an interactive style format, the speakers will provide strategic and hands-on guidance for practice leaders.
Learning Objectives:
Report common types of audits and investigations affecting medical practices, including those initiated by Medicare, Medicaid, and other government payers
Apply a structured approach to assessing the financial, operational, and reputational risks associated with audit and investigation activities
Manage responses to audit requests and investigations, including when to involve legal counsel to preserve privilege, protect organizational interests, and minimize business disruption
