retrospective audits

Hi,

I need a ruling / reference for a commitee I am on that indicates when preforming a retrospective audit that you must refund or reprocess any findings that are over or under coded....or not.

Thanks for your help.

Retrospective Reviews

[Hi,

I need a ruling / reference for a commitee I am on that indicates when preforming a retrospective audit that you must refund or reprocess any findings that are over or under coded....or not.

Thanks for your help.]

That is exactly why we never do retrospective reviews

Internal audits

Compliance auditing is an important tool and should be conducted. But, physician practices should understand the potential risks involved in auditing and the ways to minimize risks. For example, if a physician practice finds and is aware of overpayments involving Medicare and other governmental programs, through an internal audit or is otherwise aware, and fails to return those overpayments, the physician practice can have criminal exposure under Federal law.
Internal audits without the direction of legal counsel means the audit and all findings, including potentially harmful information, will not be protected. The attorney/client privilege may not be upheld in all situations, but in order to provide the best protection for the practice audits should be directed by counsel.