“Because health care is constantly changing, it makes sense that a career specializing in this area will be exciting and provide ample opportunities for growth.” Jim Erickson, CPA, member and Mark Hilton, CPA, member (Partners-in-Charge of the Cost Report Attest and DSH Audit Team)
The firms first attest engagements began in the early 1980s with projects in Indiana and Colorado. Over the next three decades the firms audit team has served, or is currently serving, cost report audit and attest clients in more than 20 states and processes nearly 10,000 cost reports annually.
Since 1998, Myers and Stauffer has provided health care fraud investigation services to various agencies of the Department of Justice (DOJ), including the criminal and civil divisions of the United States Department of Justice Commercial Litigation Branch, the FBI and various assistant United States attorneys. We have performed highlyspecialized services in the fight against health care fraud. We have experts on staff that are intimately familiar with the numerous Medicare, Medicaid, Tri-Care and private insurance rules and regulations, and have helped the DOJ further understand intricacies of fraudulent schemes used in health care billing, claims and cost reporting. We have provided statistical support that will withstand potential defense counsel inquiries. We have provided medical expertise for the review of medical records for the identification of services not rendered, upcoding, padding, unnecessary services and other fraudulent activities. Our professionals are not just accountants and auditors, but also highly trained and knowledgeable health care experts in areas including, but not limited to, claims, cost reports, the application of federal and state regulations, valuations and asset tracing.
In December 2008 CMS, the agency that provides federal oversight of the Medicare and Medicaid programs, issued a final rule that required states to perform audit work related to their disproportionate share hospital (DSH) payment programs. Audits began in 2009 and Myers and Stauffer currently assists over 35 states with their DSH audit process.
The combined services of the engagement team, cost report audit/attest, litigation support, and DSH attest currently account for over 35% of firm revenue.
State Medicaid agencies reimburse health care providers billions of dollars yearly for providing health care services to their states most fragile populations. The audits employed by these states assist them in ensuring that those dollars are being used economically and to reimburse providers for the allowable costs of providing those services. Providing independent attest services to our clients provides them with assurance that their limited resources are being distributed appropriately, and at the same time provides the health care community with assurance that they are being treated fairly in relation to their peers.
The audit engagement team provides a great opportunity for individuals to learn health care. When performing cost report audits, DSH audits or litigation support services it is imperative that our staff understand, not only professional standards related to the audit environment, but also the health care industry under audit. This provides staff with opportunities to also consult with state agencies on modifications to reimbursement systems, best practices throughout the country or trends in costs incurred by health care providers. As health care becomes increasingly complicated and regulated, state Medicaid agencies will need additional oversight resources. As the leader in providing this type of service to government-sponsored health care programs, Myers and Stauffer is in a unique position to assist states in managing the growth of their health care budgets.