Whom should an auditor consult when confusion arises about an audit of improper payments?

When confusion arises about an audit of improper payments, consulting legal counsel is essential because they possess the expertise to navigate complex legal and regulatory issues concerning healthcare compliance. Legal experts can provide guidance on the interpretation of laws and regulations governing medical billing and coding, helping to clarify any uncertainties regarding potential violations. Additionally, they can advise on the implications of findings during the audit, ensuring that the processes followed are in compliance with legal standards and protecting the integrity of the audit.

In contrast, while the healthcare provider may have insights on clinical practices, they may not fully understand the legal ramifications of payment issues. The billing department may offer valuable information regarding coding and billing procedures but may lack the necessary perspective on legal compliance. Involving the patient may raise privacy concerns and is unlikely to provide clarity concerning billing guidelines or regulations. Therefore, legal counsel is the most appropriate resource when navigating complexities in an audit related to improper payments.