Protect Your Practice Part 2: Insurance Audits

This blog is Part 2 of our series, Protect Your Practice.

When a health care provider becomes the subject of an audit by an insurer, it is critical that the provider respond promptly and with caution to protect their practice. Regardless of how the audit begins (whether it is a random check or an investigation of an identified concern), the consequences of an audit or investigation by an insurer can be serious and far reaching.

There are a few important differences between an audit by an insurer and an investigation by a professional regulator (for more on regulatory investigations, please see Part 1). Insurance companies do not have statutory powers of investigation, but they control who they are willing to do business with. Insurance companies are corporate entities who have no obligation to accept or approve insurance claims related to care from a health care provider. If insurers have concerns about a provider's practices, they may choose to "delist" the