Physical Therapy Billing Compliance | Can you afford to fail an audit?

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physical therapy billing compliance audit penaltiesWhen it rains, it pours. Just when Shannon thought it could not get any worse for her physical therapy practice after failing a recent audit, she received another letter from Blue Insurance. This time they wanted her to pay back the money she had already received for the claims that failed the audit in addition to paying a hefty penalty of $30,000.

“Maybe you should contact a compliance expert,” Mike said. “He might be able to help you navigate through this audit-aftermath without losing your practice.”

Shannon was trying to fight back the tears as she responded: “I guess it’s worth a shot.” She was not sure anyone could help her make it through this audit fiasko in one piece, but she had to at least try to save her dream of having her own physical therapy practice.

When she met the physical compliance expert, David, later that week, she did her best to stay composed as he prepared her for the worst case scenario.

“My biggest concern right now is that Blue Insurance will blacklist you,” David explained. “Because once they do, all the other insurance companies will come after you like a pack of wolves, and you will be dealing with even more audits.”

“I have a feeling that is not even the worst that can happen,” said Shannon.

“Unfortunately, it’s not,” David admitted. “You could also lose your license, not to mention the legal fees you would incur if they take you to court. In case you are convicted for fraud, you could also serve time.”

Shannon swallowed hard. She started thinking about her patients. What were the chances of her patients staying loyal throughout these fraud accusations? It’s not like they would understand how difficult the insurance companies made it for PTs to stay compliant. Would anyone believe that she really was not trying to cut corners?

“Is there any way to do damage control so that I don’t lose my patient base?” she asked as her voice quivered with fear. “I realize I probably won’t get any referrals until this is over. But I can’t afford losing my current patients, too.”

David sighed. He felt Shannon’s pain and wanted to reassure her. But he had to avoid giving her false hope. She had to be ready for an uphill battle, no matter how ugly it might get, if she wanted to prevail.

Have you ever been audited or do you know anyone who was audited?
What was the worst part about it?

Leave your comments below!

4 replies
  2. Ravi Mahajan
    Ravi Mahajan says:

    Dr. Ben Carson is the latest on the growing list of conservatives targeted by the Internal Revenue Service.

    The well-known neurosurgeon told The Washington Times
    the IRS hit him with an audit just months after his speech at the
    National Prayer Breakfast in which he talked about the nation’s “moral
    decay and fiscal irresponsibility” in front of the president.

    “I
    guess it could be a coincidence, but I never had been audited before
    and never really had any encounters with the IRS,” Carson said. “But it
    certainly would make one suspicious because we know now the IRS has been
    used for political purposes and therefore actions like this come under
    suspicion.”

    The tax authority found no wrongdoing
    following a full audit that stretched from June to August, but Carson
    said it raised his suspicions about being singled out for his speech.

    Tea
    party groups, the Rev. Franklin Graham and the National Organization
    for Marriage are also among those who’ve been singled out for special
    scrutiny by the IRS.

  3. Ravi Mahajan
    Ravi Mahajan says:

    Dr. Ben Carson is the latest on the growing list of conservatives targeted by the Internal Revenue Service.

    The well-known neurosurgeon told The Washington Times
    the IRS hit him with an audit just months after his speech at the
    National Prayer Breakfast in which he talked about the nation’s “moral
    decay and fiscal irresponsibility” in front of the president.

    “I guess it could be a coincidence, but I never had
    been audited before and never really had any encounters with the IRS,”
    Carson said. “But it certainly would make one suspicious because we know
    now the IRS has been used for political purposes and therefore actions
    like this come under suspicion.”

    The tax authority found no wrongdoing following a
    full audit that stretched from June to August, but Carson said it raised
    his suspicions about being singled out for his speech.

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