Like the insidious omicron variant of the COVID-19 virus, America’s healthcare auditors are, in many cases, auditing claims with complete abandon, forsaking rules created specifically to curb payor abuse. And driven by profit motive, many commercial payors, in fulfilling their corporate mandate to manage risk and save money, find the low-hanging fruit to be ripe for harvesting.

While the Centers for Medicare & Medicaid Services (CMS) continues to punish providers for claims submitted with errors of omission, the same disciplinary action is infrequently demonstrated publicly against payors behaving badly. It’s little wonder, in today’s highly regulated healthcare environment, that the audit landscape is fraught with peril for providers. Most notably, Medicare Advantage (MA) plans can tend to skirt the rules and audit records recklessly.

For the latest national updates on auditing gone awry, listen to the next live edition of Monitor Mondays.

Learn from an array of trusted subject matter experts who will report on the auditing landscape, while explaining how to protect your facility from recoupment of revenue:

• The RAC Report: Healthcare attorney Knicole Emanuel, partner at the law firm of Practus, will report the latest news about auditors, including the Recovery Auditors (RAs).
  
  
• The Whistleblower Report: RACmonitor’s resident physician and attorney, Dr. John K. Hall, will report on the unusual verdict in the case of Sheldon versus Allegan Sales, LLC.
  
  
• Risky Business: Healthcare attorney David Glaser, shareholder in the law offices of Fredrikson & Bryon, will join the broadcast with his trademark segment.
  
  
• Monday Rounds: Ronald Hirsch, MD, vice president of R1 RCM, will be making his Monday Rounds with another installment of his popular segment.
  
  
•  Legislative Update: Cate Brantley, Legislative Analyst at Zelis Healthcare, will report on current healthcare legislation.
  
  
• SDoH Report: Lenel James, MBA, will report on the news that’s happening at the intersection of healthcare regulations and the SDoH.