UHC Medicare Random Audits
David Hewett
Description
Collection
Title:
UHC Medicare Random Audits
Creator:
David Hewett
Date:
4/17/2018
Text:
Has anyone been receiving 'Random Audits' from UHC Medicare after billing for prosthetics that have been prior approved?
UHC on Medicare plans requires prior approval for prosthetics. Which we understand and follow the rules. On the last five prosthetic cases we received the prior approval as required and then proceeded to deliver and bill the prostheses.
On each one we then received notification that the claim was chosen for a “Random Audit”.The auditor claimed the documents were not legible so we had to resend all the information from the original prior approval. Obviously that was not true as UHC approved it with a prior authorization case number.
When I received number four out of four 'Random Audit' I knew this was not random and statistically impossible. On the second, third and fourth claims we called Optum, as they were doing the random audit and asked to speak with a supervisor. We want to know why on every prior approved claim from UHC we are getting randomly audited? Optum informed us they are directed by UHC to re audit every expensive claim. We also called UHC and they said that Optum is the one who pulls the claims for the audits. Optum ensured us that it is not them.
At this point obviously this was a deliberate delay tactic to not pay providers. We sent a letter to our state insurance commissioner to complain about these 'random audits'. The insurance commissioner responded and said since these are UHC Medicare plans we would need to contact the Medicare agency that oversees them.
Now that we have received 5 out of 5 I’m extremely Hot about this. We have won every single one but have spent significant Administration man hours to deal with this. We are in the process of filing a formal complaint.
My question to the list serve is any one else getting these bogus 'Random Audits' from UHC to deliberately delay payments?
Thanks,
Dave
David Hewett, CP, ATP, BOCPO
52 National Drive 567 Vauxhall St Ext, Unit 109
Glastonbury, CT 06033 Waterford, CT 06385
Phone: 860-633-7298 Phone: 860-333-1045
Fax: 860-659-1282 Fax: 860-659-1282
www.AdaptiveCT.com
Artificial Limbs, Custom Orthopedic Bracing
Celebrating Our 20 Year Anniversary of Serving Our Clients
Warning: The information contained in this message is privileged, confidential and intended for the individual or entity names. If this is sent to you in error please destroy this copy.
UHC on Medicare plans requires prior approval for prosthetics. Which we understand and follow the rules. On the last five prosthetic cases we received the prior approval as required and then proceeded to deliver and bill the prostheses.
On each one we then received notification that the claim was chosen for a “Random Audit”.The auditor claimed the documents were not legible so we had to resend all the information from the original prior approval. Obviously that was not true as UHC approved it with a prior authorization case number.
When I received number four out of four 'Random Audit' I knew this was not random and statistically impossible. On the second, third and fourth claims we called Optum, as they were doing the random audit and asked to speak with a supervisor. We want to know why on every prior approved claim from UHC we are getting randomly audited? Optum informed us they are directed by UHC to re audit every expensive claim. We also called UHC and they said that Optum is the one who pulls the claims for the audits. Optum ensured us that it is not them.
At this point obviously this was a deliberate delay tactic to not pay providers. We sent a letter to our state insurance commissioner to complain about these 'random audits'. The insurance commissioner responded and said since these are UHC Medicare plans we would need to contact the Medicare agency that oversees them.
Now that we have received 5 out of 5 I’m extremely Hot about this. We have won every single one but have spent significant Administration man hours to deal with this. We are in the process of filing a formal complaint.
My question to the list serve is any one else getting these bogus 'Random Audits' from UHC to deliberately delay payments?
Thanks,
Dave
David Hewett, CP, ATP, BOCPO
52 National Drive 567 Vauxhall St Ext, Unit 109
Glastonbury, CT 06033 Waterford, CT 06385
Phone: 860-633-7298 Phone: 860-333-1045
Fax: 860-659-1282 Fax: 860-659-1282
www.AdaptiveCT.com
Artificial Limbs, Custom Orthopedic Bracing
Celebrating Our 20 Year Anniversary of Serving Our Clients
Warning: The information contained in this message is privileged, confidential and intended for the individual or entity names. If this is sent to you in error please destroy this copy.
Citation
David Hewett, “UHC Medicare Random Audits,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 24, 2024, https://library.drfop.org/items/show/208898.
