Wachler & Associates Health Law BlogMichigan Medicaid Reminds Providers of Audit Requirements
The Michigan Medicaid program recently sent a program-wide email to healthcare providers and suppliers reminding them of certain duties under the Michigan Medicaid program. Specifically, the Michigan Department of Health and Human Services (“MDHHS”), which oversees the Michigan Medicaid program, emailed providers that:
“As a reminder, all Medicaid-reimbursed services are subject to review for conformity with accepted medical practice and Medicaid coverage and limitations. The Michigan Department of Health and Human Services (MDHHS) conducts post-payment reviews to verify services, providers, settings, and appropriate billing. Providers must, upon request from authorized agents of the state or federal government, make available for examination and photocopying all medical records, quality assurance documents, financial records, administrative records, and other documents and records that must be maintained. Providers must maintain, in English and a legible manner, written or electronic records necessary to fully disclose and document the extent of services provided to beneficiaries. The records are to be retained for a period of not less than seven years from the date of service, regardless of a change in ownership or termination of participation in Medicaid for any reason.”
Generally, each of these is a basic program requirement applicable to all providers and suppliers who submit claims to the Michigan Medicaid program and are found in state statute, regulation, policy, participation agreement, or other sources.
It is unknown why MDHHS reminded providers of basic program requirements, but it may signal a renewed focus by MDHHS on conducting audits of Medicaid providers after the various pauses of audit activity and personnel shortages during the COVID-19 pandemic. Providers who bill services to Michigan Medicaid, or any third-party payor, should be aware of the requirements to which the provider is bound regarding coverage requirements, billing and coding guidelines, documentation retention and production, enrollment and credentialling, and other program requirements. A provider who does not comply with program requirements or who does not maintain documentation demonstrating its compliance, may find itself unable to defend itself in audits conducted by MDHHS or the payor and subject to demands that it repay significant amounts to the Michigan Medicaid Program or other payor, sometimes several years after the provider initially billed the claim and received reimbursement. Given the recent reminder from MDHHS, Michigan Medicaid providers and suppliers should review their compliance programs and billing and documentation practices, in the event that MDHHS initiates a new series of audits.
For over 35 years, Wachler & Associates has represented healthcare providers and suppliers nationwide in a variety of health law matters, and our attorneys can assist providers and suppliers in understanding new developments in healthcare law and regulation. If you or your healthcare entity has any questions pertaining to healthcare compliance, please contact an experienced healthcare attorney at 248-544-0888 or wapc@wachler.com.