OIG Audit & Multi-Million Dollar Payback

Primary Care practices are being audited — and some are now being required to repay millions of dollars to the government. The root causes are painfully familiar:

• Diagnoses carried forward without current-year support

• Problem lists used as billing sources

• Missing documentation for chronic conditions

• Coding patterns that don’t match clinical evidence

• Lack of internal audits or provider education

These aren’t bad actors. They’re overwhelmed practices relying on workflows that weren’t built to withstand today’s audit scrutiny.

Recent federal findings show just how costly these gaps can be:

• $907K in Medicare Part B overpayments due to non-compliant professional claims

• $2.6M in unallowable payments from missing documentation

• $7M in Medicare Advantage overpayments caused by unsupported diagnosis codes

• $12M DOJ fraud case involving services never performed and ghost billing offices

If you’re unsure whether your documentation and coding would hold up under review, even a small sample can reveal a lot.

How ProTrust Billing Partners Protects Independent PCPs

ProTrust helps practices build audit‑ready operations through:

• Full-service billing with integrated risk adjustment oversight - Ensuring claims, coding, and documentation align with federal expectations.

• HCC coding review & annual recapture workflows - Supporting accurate, compliant chronic condition capture.

• Monthly documentation audits & provider education - Closing gaps before payors or auditors find them.

• RAF monitoring & reporting - Keeping your risk profile accurate and defensible.

• EHR workflow optimization - Reducing documentation burden while improving accuracy.

• Suspecting & gap‑closure support - Helping providers capture what’s clinically present — and only what’s supported.

• Micro‑audits with actionable improvement plans - Clear, practical recommendations your team can implement immediately.

• Provider coaching & education - Real‑world, provider‑friendly guidance that sticks.

🎁 Free 10‑Chart Audit for New Practices

If you’re unsure whether your documentation and coding would withstand an audit, we offer a complimentary 10‑chart audit for new practices.

You’ll receive:

• Documentation gap analysis

• HCC accuracy review

• Clear examples of what’s supported vs. unsupported

• A short list of high‑impact improvements

Even a small sample can reveal early risks — and prevent costly surprises later.