Blog by Attorney Knicole C. Emanuel at Practus, LLP in Raleigh, NC where she concentrates on Medicare and Medicaid regulatory compliance litigation. See legal disclaimer @ "About Knicole."
Please take the time to read her blogs. She explains the Medicaid problem from a legal point-of-view. She also highlights most medical providers' due process or rights are violated during most Medicaid Audits especially when there is no fraud, waste or abuse. Often times the problem is a deficiency or an error with the paperwork (e.g. medical documentation), but the auditor does not care and interprets the current guidelines or rules in favor of the health insurance company. And this leaves the medical provider defenseless and fighting an up-hill battle to prove he/she did follow the guidelines and rules, but in his/her own clinical way.
And this is where the true problem "hides" because there is no middle man to represent or assist the medical provider throughout this process. We as medical providers can appeal each case, but we can’t appeal the entire Medicaid Audit. We as medical providers can attend a Fair Hearing and speak to a Hearing Officer for each case. We as medical providers can try and hire an attorney and sue Medicaid to get loss income, but these are not sure ways to correct the problem. Sorry, this is me on my soapbox.
Ultimately, the new law or laws in South Carolina can protect medical providers as they go through a Medicaid Audit. And limit the auditor's power when there is no fraud, waste, or abuse. If the South Carolina government does not limit the auditor's power, the auditor will continue to mistreat, abuse, belittle, attack, dismiss, and ignore medical providers when there is no Medicaid Fraud, Waste, or Abuse. The struggle is real and it needs to be addressed!
P.S. It looks like what we are asking for "might be in the works." Senator Tim Scott teamed up with other US Senators and wrote a letter to the US Government Accountability Office (watchdog for all taxpayers money). Another blog post from Attorney Knicole Emanuel.
Here is the link to the blog and the senators' letter. https://medicaidlawnc.com/2022/07/25/senators-question-rac-audits/