Medical Auditing Practice Exam

Dr. Black receives a demand letter from the OIG regarding claims submitted. What should he request?

1. A monetary settlement

2. A hearing before an HHS administrative court judge

3. A review by an independent auditor

4. Immediate dismissal of the claims

The correct answer is: A hearing before an HHS administrative court judge

Requesting a hearing before an HHS administrative court judge is a strategic and important step when dealing with a demand letter from the Office of Inspector General (OIG). This hearing provides a formal legal process where Dr. Black can present his case, argue against the claims made by the OIG, and seek resolution. Engaging in this process allows for a transparent review of the issues at hand. The administrative court will examine the evidence and arguments from both sides, which can lead to a more equitable outcome. Additionally, a hearing can offer Dr. Black the opportunity to clarify misunderstandings, present supplementary evidence, and defend his compliance with applicable laws and regulations. Options such as requesting a monetary settlement may prematurely acknowledge fault or liability without fully disputing the OIG's claims. Similarly, pursuing an independent audit may provide insights but does not replace the need for a formal legal process to address the OIG's concerns directly. Requesting immediate dismissal of claims likely lacks the legal standing needed to challenge the OIG's demand effectively. Therefore, seeking a hearing is the most prudent course of action.