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Humana is Auditing or Terminating You. Without the right legal defense, you may face significant penalties and network exclusion. At Health Law Alliance, our legal team has successfully defended hundreds of clients against payor audits, Fraud, Waste & Abuse (FWA) investigations, and network terminations. We have prevailed against Humana and have proven strategies for the audit and appeal process. Contact Us now for help.
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Former Government Regulators on Your Side – Our team of healthcare defense specialists is spearheaded by former federal and state prosecutors who understand how the government and its contractors use data mining and proprietary algorithms to identify potential Fraud, Waste & Abuse (FWA) for audits and investigation. Because we understand how the government builds cases, we use their playbook to beat them.
Healthcare Specialty Attorneys and Consultants – Health Law Alliance specializes in healthcare law and is dedicated to defending providers and their licenses from overreach. Our founding partner previously served as a top executive for the biggest companies in healthcare, including McKesson, Relay Health, CoverMyMeds, United Health Group, Optum, and United Healthcare. We know the tricks insurance companies use to deny claims, and use that inside information against them.
Proven Track Record – Some clients turn to us when stakes are the highest, when their businesses are threatened, when their license is challenged, and when their options are limited. Our wins against the government and insurance companies can be reviewed HERE. Many more clients, however, turn to us at the first sign of potential trouble, when we can neutralize the problem before it grows. Either way, we have your back from beginning to end.
Humana Audit Defense: Common Questions
What triggers a Humana audit?
Humana audits can be triggered by a variety of factors, including unusual billing patterns, high-cost claims, or non-compliance with Humana’s contract requirements. Sometimes, audits are random, while other times they’re based on suspected policy violations. If you’ve received an audit notice from Humana, it’s essential to seek legal counsel to prepare an appropriate response and minimize risks.
What consequences can I face in a Humana audit?
The outcomes of a Humana audit can vary widely, from repayment demands to contract termination. In some cases, Humana may impose financial penalties or remove you from their network if they find significant issues. Health Law Alliance specializes in defending against these consequences, using a detailed approach to dispute findings and protect your practice’s financial health.
How can Health Law Alliance help with a Humana audit?
Our attorneys assist in every stage of the Humana audit process. From initial response and document preparation to challenging unfavorable findings, we provide comprehensive support. Health Law Alliance leverages extensive experience in payor audits, particularly with Humana, to protect your livelihood and ensure compliance with Humana’s complex standards.
What steps should I take after receiving a Humana audit notice?
Upon receiving an audit notice from Humana, start by reviewing the document to understand the audit’s scope and deadlines. Avoid responding immediately without legal advice. Health Law Alliance can help you prepare a strategic response, gather the necessary documents, and communicate with Humana on your behalf to ensure a robust defense.
How long does the Humana audit process typically take?
The duration of a Humana audit can vary depending on the scope, response times, and any disputes that arise. Some audits are resolved in a few months, while others can take longer if there are complex issues or negotiations involved. Health Law Alliance assists in streamlining this process, advocating for a fair resolution as efficiently as possible.
Can Health Law Alliance help prevent future audits from Humana?
While it’s impossible to completely prevent future audits, Health Law Alliance offers compliance support to reduce audit triggers. We help identify potential areas of vulnerability in your practice and advise on best practices to align with Humana’s audit standards, which can minimize the risk of future scrutiny.
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