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Our attorneys stay on top of changes in legislation, agency regulations, case law, and industry trends—then craft timely legal alerts to keep clients up to date on legal developments important to their business.

March 12, 2021

Matter of Poole: OMIG "System Match" Data Audits Rejected as a Basis for Findings

Barclay Damon is very excited to report a key decision in our client’s favor after a hearing dealing with the core issues in all of our “coordinated” data match OMIG audits involving over $8 million in initial findings.

In a critical decision in a lead case issued after four days of hearing, our Barclay Damon Transportation Audit Team obtained a favorable decision that has now yielded clear precedent that will limit and even end the slew of audits that ignore valid, contemporaneous provider documentation and rely solely upon claims entry data that we and our experts believe is flawed and corrupted.

OMIG had pursued over 100 “system match” audits based solely upon claiming data, but refused to consider valid claiming documentation. In a trio of cases, binding upon OMIG and culminating in Poole, the agency’s ALJ’s have now foreclosed OMIG’s use of this lucrative, but highly controversial, auditing practice that threatened to render documentation requirements moot and cause a complete forfeiture of payments to providers based upon novel and immaterial inconsistencies or errors in electronic claiming data. This is good news for providers of all kinds who may resort to documentation kept per regulations to support claims upon audit.

If you are facing payer or governmental audit liabilities, contact the firm’s Health Care Controversies Audit Team for a free consultation as early as possible in the process to see how we can help.

If you have any questions regarding the content of this alert, please contact Linda Clark, Health Care Controversies Practice Area chair, at lclark@barclaydamon.com; Jerry Solomon, special counsel, at jsolomon@barclaydamon.com; or another member of the firm’s Health Care Controversies Practice Area.

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