Ask the legal expert ... about using external auditors

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Attorney John Durso, Ungaretti & Harris LLP
Attorney John Durso, Ungaretti & Harris LLP

What do you advise about using external auditors to check what we're doing — before wave after wave of government auditors come in?

A difficulty with self-preemptive auditing is you do not know when or for what period you will be reviewed. We recommend you have a dedicated team of coders and a process for immediate review and assurance of proper coding.

Avail yourself of the attorney-client privilege: You and counsel are bound to make corrections and engage in self-reporting, but doing so with privileged and accurate advice will make the process somewhat less frustrating. 

Any time you are looking into a serious coding issue (and potential repayment concerns fit that category) we would advise that you engage your attorney to retain a coding audit expert. That allows the work to be done by a outside expert but cloaked with attorney work product.

This allows counsel to share the information with only top administrators and prevents other staff members from documenting some perceived coding issue in a non-privileged record.  

Controlling who looks at your audit results should be limited to counsel and those in administration who need to address the issue. Letting regular staff conduct such a review opens your organization up to potential erroneous but distracting whistleblower claims. 

Allowing auditors you hire or staff to do some follow-up review can sometimes uncover items misunderstood by the staff. This creates significant issues dealing with the results without any privilege of shelter for the information. 

If their work is contained within attorney-client privilege, the auditors hired through your attorneys will keep a tight lid on what they observe, and you will benefit from advice without misunderstandings.