New Proposed Bill Would Require Medicare To Notify Providers Of An Audit By Email, Phone, & Mail

A new bill has been introduced that would require Medicare to notify providers of an audit by email, phone, and mail.

Video Transcript

JIM BENEMANN: Well, likely all of us have missed an email or two because it went to our spam folder. But imagine if a couple of missed emails resulted in the state taking tens of thousands of dollars from you. Hard to believe, but it happened to one business owner. Could happen again, unless lawmakers make changes.

Here's our political specialist Shaun Boyd. Shaun, that's a scary scenario.

SHAUN BOYD: Jim, this was devastating for the business owner you're about to meet. She's a Medicaid provider who lost nearly $50,000 after two emails from the state got lost in spam. No phone call. No letter. No recourse. The state just took back the money. Now she's taking action to protect others.

For 15 years, Wildflower Assisted Living has cared for people with brain injuries, most of them Medicaid recipients. So when the state sent an email last year notifying owner Nicole Schiavone of a planned audit, she thought nothing of it.

NICOLE SCHIAVONE: And then I didn't hear anything. And then COVID hit, and so I was like, well, maybe they're not doing them.

SHAUN BOYD: Turns out she was wrong. The state had sent two subsequent emails requesting documentation.

NICOLE SCHIAVONE: The notice went into my spam.

SHAUN BOYD: By the time she found out, she was out nearly $50,000, money the state clawed back.

NICOLE SCHIAVONE: And I said, hey, guys what's going on? Like, you have my phone number, you have addresses of all five locations and my billing address. Like, you could have sent a letter.

SHAUN BOYD: That's where Senator Jeff Bridges comes in.

JEFF BRIDGES: I took a look at it. And said, yeah, this is nuts, this has to get fixed.

SHAUN BOYD: He introduced a bill that requires the state notify Medicaid providers of an audit with an email, letter, and phone call, before it recoups the money.

JEFF BRIDGES: For me, this is about good government. Governments need to be accountable in order to have the trust of the folks we represent. This was brought to us. We said, you're right, this isn't the way the government should work, and we're fixing it.

SHAUN BOYD: Going forward, Schiavone, though, is out of luck, out nearly $50,000.

NICOLE SCHIAVONE: There's no way in the Medicaid industry to make that money up.

SHAUN BOYD: A spokesperson for the State Department that oversees Medicaid told me that once that audit deadline has passed, by law, they have to recoup the money unaccounted for regardless of the reason. He was unsure how many other business owners have had similar experiences. The bill did pass its first committee.

Live at the Capitol, Shaun Boyd, "Covering Colorado First."