Behavioral health and substance use treatment providers are audited by Medicaid program integrity offices, managed care organizations and commercial payors. Common issues include documentation of medical necessity, treatment plans and progress notes, session length and supervision, group and telehealth billing, and the credentials of the clinician who delivered the service.

We take over communications with the auditor at the first notice, organize the record, respond to requests and review draft findings. Where findings rest on a sample extrapolated to a larger universe of claims, we examine the method and challenge it when appropriate, and we pursue appeals and hearings when a final determination issues.

We also help providers evaluate whether to self-disclose overpayments, negotiate repayment terms, and respond to payment suspensions and referrals to law enforcement or licensing agencies. For payor contract disputes, we review termination, audit and appeal provisions and pursue relief through the contract's process, arbitration or court.

Preventively, we conduct compliance reviews and mock audits of documentation and billing practices so that weaknesses are fixed before an auditor finds them.