Surviving a Medicare Audit: Warn Lab Staffers Not to Lie to Auditors

As a lab compliance director, you understand the dangers of obstructing a Medicare audit. The problem is your staff may not. So, make it clear to any staffer that may come into contact with an auditor visiting your facility that lying to a Medicare auditor is a form of obstruction that can get them jailed.

A Cautionary Tale
To drive home your point about not lying to auditors, you might want to relate the sad story of the 73-year-old endocrinologist specializing in diabetes management who just learned that lesson the hard way.

The Medicare program integrity contractor was auditing his practice after his wife, who worked for an outside home health agency, became the subject of a Medicare fraud investigation. During the audit, the physician told the auditor that a third-party employer was renting office space. In fact, his wife would later admit after pleading guilty to health care fraud that she was actually using the space to improperly access patient data that was then used to generate referrals from the practice to the HHA without regard to medical necessity.

In addition to $118,831 in restitution, the doctor was sentenced to five months in jail followed by three years of supervised release.

Medicare/Medicaid Integrity Contract Auditor Alphabet Soup

CMS uses different contract auditors to investigate participating providers, whether at random, in response to a particular suspicion, and/or as part of a targeted audit initiative:

CERT: Comprehensive Error Rate Testing Contractor
MAC: Medicare Administrative Contractor
RAC: Recovery Audit Contractor
UPIC: Unified Program Integrity Contractor