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MAC Audits: Your Professional License is at Risk

Posted by Joseph D. Lento | Dec 06, 2022 | 0 Comments

There is no shortage of oversight in healthcare. Insurers, especially, want to make sure claims are filed in accordance with policy terms and that they aren't being overbilled for services. Likewise, healthcare workers must often balance this reality with having to advocate on behalf of patients for insurance coverage. Even when procedures are medically necessary in the eyes of the provider, insurance auditors are more than happy to scrutinize those decisions.

Professionally licensed healthcare providers must be particularly diligent when facilitating a MAC audit of their records. MAC, short for Medicare Administrative Contractor, audits can be intimidating for good reason. Their findings could trigger a disciplinary process against your license.

What to Expect During a MAC Audit

When your healthcare service provider undergoes a MAC audit, the process will be lengthy, tedious, and stressful. The provider will be expected to provide the MAC auditor with billing records, and the auditor may subject employees to questions regarding billing practices.

A MAC auditor's primary purpose is to determine whether a healthcare service provider has overbilled Medicare for medical treatment. This is a slippery slope for healthcare providers who have taken an oath to provide the best treatment to their patients. Many medical professionals are torn between adhering to insurance definitions and providing their patients with the best medical care they can provide. It's unfortunate that there's any disconnect to begin with, but too often the MAC auditors will conclude that the medical provider overbilled for services and must repay Medicare.

When a MAC audit implies you might be guilty of insurance fraud, your professional license could be in jeopardy.

Defending Your Professional License After a MAC Audit

If suspected Medicare fraud is reported to your state licensing board, you'll be investigated. The act of “performing unnecessary work or unauthorized services” constitute a violation of the rules of professional conduct in New York, for example. Even if the board doesn't decide to completely revoke your license, it could suspend your license and render you unemployable while the suspension remains in effect. There is a lot to lose in these scenarios.

Sometimes there is more going on than a simple mistake, and a provider may have overbilled Medicare out of negligence or even with intention. Even when this occurs, licensed healthcare professionals should fight to course correct and save their license. Just because you made a mistake or experienced a lapse in judgment

Retain a Professional License Defense Lawyer ASAP

It's wise to speak to a professional licensed defense lawyer if you are audited for your Medicare billing practices. Attorney Joseph D. Lento has guided numerous licensed medical professionals through the process of defending their licenses, and he can help you too. To learn how Attorney Lento and his dedicated team can help you protect your medical license after a MAC audit, call the Lento Law Firm at 888-535-3686 today, or contact us online.

About the Author

Joseph D. Lento

"I pride myself on having heart and driving hard to get results!" Attorney Joseph D. Lento has unparalleled experience fighting for the futures of his professional clients in Pennsylvania, New Jersey, New York, and also nationwide. With unparalleled experience occupying several roles in the justice system outside of being an attorney, Joseph D. Lento can give you valuable behind-the-scenes insight as to what is happening during all phases of the legal process. Joseph D. Lento is licensed in Pennsylvania, New Jersey, and New York, and is admitted pro hac vice as needed nationwide. In the courtroom and in life, attorney Joseph D. Lento stands up when the bell rings!

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