The carrier further demanded that repayment be made within 30 days. The family physicians thought they were complying with the rules and had never been notified by their carrier of any billing problems. Nonetheless, they agreed to settle with HCFA because they could not risk an even more protracted and expensive audit. Afterwards, all three physicians dropped Medicare because they feared they would be unable to comply with its burdensome and confusing policies, and avoid another onerous audit in the future. Many elderly patients in Idaho Falls thus lost their primary care physician.
Many physicians hear from their carriers about billing errors during a post-payment audit.
Instead of using this first audit to teach correct billing practices, carriers immediately impose punitive actions, extrapolating from the few errors identified in a sample of charts to claim that physicians have been overpaid by tens of thousands of dollars. This would be like the IRS saying that, because it identified an error on one of your returns, it would assume you made the same error on your return each year and require that you pay back taxes for all of them. Delay recoupment efforts until appeals are heard. HCFA requires that overpayment amounts be repaid within 30 to 60 days, but when physicians appeal HCFA determinations, it can be months, or even years, after they have already paid these huge sums before they get a hearing before a judge. Provide meaningful appeal options.