Healthcare Audit Defense Attorney
“Routine audits” are becoming less routine, more common and more aggressive. Whether stemming from insurance companies, the Texas State Medical & Dental Boards, Medicare and Medicaid programs, or the countless additional Texas licensing agencies, it is imperative to respond promptly. If you have become entangled in an audit our firm can help.
As a licensed dentist and practicing attorney, Dr. Hieu Huynh has a unique vantage point. With decades as a practicing dentist in the trenches, a healthcare business owner, and a healthcare attorney, Dr. Huynh understands the challenges faced by medical and dental providers. His experience and rare insight from owning of a group of dental offices in Southeast Texas provides him with a deep understanding of the business, compliance and legal aspects of a small healthcare business owner.
Our most recent success in December of 2024 involved fighting a $444,000+ recoupment demand from United Healthcare on behalf of a physician, reducing it to a $50,000 settlement. This is just one example of the many aggressive demands providers are facing, and how we can help. Our firm has extensive experience in defending against recoupment demands, board licensing matters, EHR grant repayment demands, board licensing matters, employee/Texas Workforce Commission inquires, OSHA audits and more.
If you are already involved in an audit, it is crucial to engage in competent representation as soon as possible to help prevent any potential negative ramifications as well as increasing the likely hood of dismissal. Civil financial penalties as well as potential criminal charges are not the only concerning factors, your professional license and reputation are at stake.
Medical and Dental Compliance and Audit Prevention
An ounce of prevention is worth a pound of cure. Of course, the best plan of action is ensuring you are in compliance before you are faced with an audit. As the saying goes, ‘hindsight is 20/20'.
We can help your practice by designing and implementing a training and compliance program. We have found that our clients have had great success with our training and compliance program in preventing inadvertent billing or coding errors before they happen. Our firm's deep data analysis of your practice will highlight billing practices that may increase your chances of being audited and help to find real world solutions to minimize such high-risk practices. We have helped many providers ensure that protocols and documentation are in compliance, that all staff are properly trained, and ensuring the systems are equip with checks and balance points to help eliminate billing errors. Billing and codes are scrutinized by elaborate programs with the latest live time algorithmic Complex utilization statistics are now compiled in an instant. Your billing patterns are constantly being analyzed and compared to industry standards.
EHR Incentive Audits
Federal regulations require states to conduct audits of payments to eligible professionals (EP) and eligible hospitals (EH) participating in the Texas Medicaid Electronic Health Records (EHR) Incentive Program. The Health and Human Services Commission (HHSC) follows policies and procedures related to audit notifications and review of audit findings in accordance with Texas Administrative Code. HHSC contracts with an independent audit firm to conduct audits of Texas Medicaid EHR Incentive Program payments. The auditors will notify each EP and EH (provider) selected for a post payment audit. If audited, the provider must complete a questionnaire and supply auditable supporting documentation to verify that the provider met the federal and state requirements for receiving Texas Medicaid EHR Incentive Program payments. After completing the audit, the auditors will issue an Audit Results Notification Letter to inform the provider of the audit outcome and explain any audit deficiencies. Providers have a ten-day (10) period to submit additional information to the auditors to demonstrate remediation or otherwise resolve deficiencies cited in the Audit Results Notification Letter. This ten-day (10) remediation period is the last opportunity for the audited provider to add documentary evidence to their case file during the entire audit and review process. Our team of attorneys help guide you through the audit process and help protect your rights.
False Claims Act, Stark Law, and Anti-Kickback Statute Defense
Our firm is also equipped to handle allegations of violations under:
- False Claims Act (FCA)
- Anti-Kickback Statute (AKS)
- Stark Law
- Exclusion Authorities
- Civil Monetary Penalties Law (CMPL)
We provide strategic representation to address these complex issues and protect your rights.
Defending Against Aggressive Insurance Recoupments
Insurance companies are increasingly using “routine audits” as a mechanism to recoup funds, often citing documentation issues as justification. These demands can run into hundreds of thousands of dollars, putting your business and livelihood at risk.
At Huynh & Huynh, PLLC, we understand how devastating these demands can be. We've successfully defended providers, reducing recoupment amounts by significant margins.
Our team is experienced in handling aggressive audits, protecting your financial stability and professional reputation. Let us fight for you.
Medical, Nursing and Dental Board Defense
If you've received a complaint from the Texas Medical Board, Texas Nursing Board, or Texas Dental Board, our firm can defend your license and reputation. All complaints begin by receiving a certified letter from the Board, typically investigating the standard of care. Respondents have ten (10) days of receipt to respond to the letter, following the requirements of business record affidavits and patient records. We can help you navigate the investigation and represent your defense. He will guide you through the entire process, from reviewing the concerns, analyzing the patient records and facts, drafting the response to the board, defend your license and reputation in front of the Board and protecting your rights. With extensive experience navigating board investigations, Dr. Huynh personally handles:
- Responding to certified letters and board inquiries.
- Reviewing patient records and drafting responses.
- Representing your case before the board.
From start to finish, we guide you through this challenging process, ensuring your rights are protected.