A Medicaid or DHS audit checks whether the services you billed were actually delivered and properly documented — and increasingly, whether your financial records back it up. The agencies that sail through are the ones whose books tie every dollar billed to a service record and a bank deposit, kept that way all year rather than reconstructed under a deadline.
At its core, an audit tests one chain: billed service → documentation that it happened → payment received. If any link is missing or inconsistent, that’s a finding. Auditors increasingly cross-check billing against payroll, attendance, and financial records — not just clinical notes.
It’s almost always the same: billing that can’t be tied back to documentation. The result is recoupment — repaying the disputed amounts, sometimes with interest, and a heavier review next time.
Don’t prepare for audits — operate audit-ready. Reconcile monthly, keep books service-linked, and retain documentation as you go. Then an audit is a request for records you already have, not a month of overtime.
NavSuccess does this for home care & healthcare agencies — see Fractional CFO & advisory.
State Medicaid / DHS program-integrity units and their contractors; for Medicare, MACs and CMS contractors. All follow the same billed-to-documented-to-paid logic.
Paying back amounts billed that the auditor determines weren’t supported — the most common and most expensive audit outcome.
Look-back periods vary by program and state, which is exactly why consistent monthly records and proper retention matter.
Book a free 30-minute consultation. We’ll look at where your books and compliance stand and show you exactly what we’d take off your plate.