If the government is paying your facility a visit, you'd better understand what they're looking for and figure out whether your organization did something wrong, says Lawrence Vernaglia, a partner in the Boston office of Foley & Lardner, LLP. "I think the goal is always to conduct your own analysis," he says. "You want to understand what the rules are and what is billable and not billable.” This investigation is not necessarily something you want to share with investigators unless you are specifically requested to do so.
One problem organizations may run into when they try to investigate a problem is the tight turnaround time they face as a result of the government's new 60-day rule. The Patient Protection and Affordable Care Act now requires all organizations that participate in Medicare and Medicaid to self-report and return overpayments within 60 days after the organization discovers the problem, says Vernaglia. This doesn't give the compliance officer a lot of time to evaluate the situation before responding, he says.