This is legit "we're combing through all of our claims to see if we can reject them after the fact." You shouldn't be happy about this. Nobody should. It costs us $70 to buy the rhogam we are mandated by state law to give all new mothers. Medicaid reimburses us $8. We are mandated by the state to lose $62 every time someone has a baby. Can we negotiate that? no. Can the state negotiate that? yes, but they don't. Does this sort of nonsense encourage you to play ICD Bingo with every fucking thing you do with the patient? Goddamn right. Took my naturopaths to lunch a couple weeks ago. One of them said "I have a hard time with vaccine visits because they're so short and my patients always ask me questions" to which the other said "then you answer their questions and bill them for a visit." Now - if she accidentally forgets to code that as an acute visit? Medicaid doesn't pay us anything. Not, they don't pay us for the vaccine (which we make $3 on - I pay our naturopaths $25), we get nothing. Here's this week's fun one. I have reason to believe that the Department of Justice came down on a colleague for using gray-market IUDs. Everyone uses gray-market IUDs. Are they labeled in English? yes. Are they made in the same factories as white-market IUDs? yes. Are they labeled "not for sale in the US?" no. But because there's a law from 1867 about labeling, there's the possibility that billing Medicaid for an IUD intended for the European market constitutes $11k worth of medical fraud. So why would you use gray market IUDs? Because Medicaid will pay you $600 to put in an IUD. The IUD costs $200 gray market and $1100 if you buy it in the US. So now? Now we're not putting in IUDs. 'cuz if I have a choice between losing $500 on every single one, making $400 on every single one or possibly losing $11k for each and every single one? That's a no-fucking-brainer. 'ZOMFG medicaid is paying for things it shouldn't' is the Welfare Queen of the modern era.Auditors flag overpayments when a patient's records fail to document that the person had the medical condition the government paid the health plan to treat, or if medical reviewers judge the illness is less severe than claimed.