Academy of Chiropractic Personal Injury & Primary Spine Care Program
Quickie Consult 170
“Retrospective Audits and the SIU”
Very few believe me when I say you must be prepared to be retrospectively audited by the insurance carriers. 3 hours ago, I received my latest call from a doctor that the very pleasant man from the special investigative unit (SIU) walked in his office claiming to be investigating 3 of his patients. The SIU officer showed his credentials and said that the carrier was very concerned that the 3 patients were not telling the truth and they needed information from the charts. This doctor very wisely said that he was busy and he would call on Monday to set up an appointment. The SIU “nice man” said if he didn’t call, the carrier would stop paying him indefinitely. He proceeded to call me instantly.
I explained that the carrier was not investigating his patients, they were investigating him and thankfully he has a few days to verify that his records are in order. He quickly called Dr. Schonfeld, the “Compliance Auditor,” because like many of you, he didn’t’ believe that his door would be knocked on and as we speak, his charts are expeditiously being audited for accuracy. At this point in time, all he can do is create an addendum with any information that he recollects on the cases, as no deletions are permissible.
If an SIU agent for the carrier knocks on your door, do not let them in and give them no information. Call your lawyer (only a health care lawyer) and have the SIU person, no matter how nice, call the lawyer directly and make arrangements to give them the information needed. One carrier, for years, sent in very young, giggly girls, who were very unassuming and got everything they wanted, only to turn it over to their lawyers in their efforts to get as much money as possible from these audits. This brings us to my point; if you haven’t chosen to have a voluntary audit yet, do so now because your door could be next and you need to be prepared. This is real and you need to be prepared because they will come when you least expect it.
Fax me your records to: 661-843-1062. An ounce of precaution is a better investment than 2 years of no sleep and more money spent than you could ever imagine. Ask anyone who has been through this and I know by now you know many. PLEASE!