Nteon Practice Consultants - High Audit Penalties

Many doctors do not believe the high audit penalties. Until they are audited.

Typical penalties range from $150,000 to over $225,000!

Every week we are ask to help practices with penalties over $1,000,000!

One doctor who was audited asked "They found $20,000. How did this become $245,000!"

The answer is Extrapolation!

This is serious!

We are frequently asked how they can penalize those high amounts. Here is what occurs.

Before an audit is scheduled, the insurance auditors review claims you previously submitted.
Based on this review, they target "suspect" claims. Claims they believe will fail.
Those are the records they request.
This provides the auditor with what they want; a higher probability of you losing an audit.
It provides them with a higher percentage of failures.
They apply that percentage to all the claims you submitted for multiple years! This is "extrapolation"
Resulting in a high penalty. More money you have to pay them!

This is an actual audit penalty calculation for a practice!

Records Reviewed
Records Failed
% of Records Failed

Total Reimbursement 2011 – 2016

Failed % of Total Reimbursement

Interest and Penalties

Total Due by Practice

45
41
91%

$127,569
$116,087
$79,695
$195,782

This is a real case! That is how the penalties exceed $100,000!