Medicaid Audits and Compliance
Preparation, on-site support, and representation through Department of Social Services field audits and contractor reviews.
Who this is for
- Providers notified of a DSS field audit or contractor review
- Organizations responding to preliminary or final audit findings
- Providers seeking a compliance review before an audit occurs
What creates risk
- Documentation that does not support reported costs or services
- Sampling and extrapolation applied to unverified populations
- Internal controls that fail under transaction testing
- Responses submitted without analysis of the underlying methodology
What CJLC reviews or prepares
- Audit notice, scope, and requested document lists
- Sampling and extrapolation techniques applied by the auditor
- Internal controls and selected transactions for documentation
- Draft findings and the regulatory basis cited for each
What you receive
- An organized, indexed audit documentation package
- Written analysis of proposed findings and exposure
- Correspondence and response support
- Corrective recommendations for future cycles
How the engagement works
- 01
Assessment of the audit notice and response deadline
- 02
Document preparation and presentation
- 03
Representation with DSS or audit contractor officials
- 04
Assistance with settlement discussions and appeals
The full CJLC engagement pathway
- 01
Initial Issue and Deadline Assessment
Identify the organization, regulatory program, reporting requirement, current concern, and applicable deadline.
- 02
Secure Document Request
Collect prior reports, rate calculations, agency correspondence, accounting records, and supporting schedules securely.
- 03
Preliminary Review
Evaluate reporting, documentation, potential exposure, and areas requiring deeper analysis.
- 04
Scope and Engagement Approval
Define responsibilities, deliverables, timing, and professional fees.
- 05
Preparation, Analysis, or Representation
Complete the cost report, audit support, reimbursement review, appeal assistance, or financial engagement.
- 06
Findings and Next-Cycle Planning
Explain results, deliver final documentation, and establish the next reporting or compliance calendar.
Request a Reimbursement and Compliance Review
Tell us the organization, the program, and the deadline. We will review fit and outline next steps.