The Dos and Don’ts of Medical Payer Audits: How to Identify and Respond to Them

Author: Guillermo J. Beades and James. M. Tudor

Dec 16, 2022 | Audit


Prior to the COVID-19 pandemic, medical providers were routinely audited by public and private payers. Since the pandemic, when many payers were forced to pay for expensive COVID-19 related testing and treatment, payer audits have increased. When a provider receives notice of a pending audit or an overpayment demand, there are specific steps that need to be taken to properly refute the findings, reduce risk, and avoid potential civil or criminal referral. Understanding the nuances in the myriad of payer audits, knowing how to respond to each, and avoiding the common pitfalls can make the difference between successfully defending an audit or having to pay back a significant amount of money.