The Myth of the 100% Error Rate: Why Specialty Expertise Matters in Medicare Audits

Medicare audits are becoming more frequent, more aggressive, and more precise—shrinking the margin for error. To protect against inflated findings, healthcare organizations must rely on statistical modeling, independent coding reviews, and specialty-specific expertise. In a recent Becker’s Healthcare webinar, VMG Health’s Pam D’Apuzzo, Managing Director of VMG Health’s Coding Audit & Compliance division and Frank Cohen, Senior Data Scientist at VMG Health, shared how to recognize when the math warrants a challenge—and how to respond effectively.

Here are three key takeaways from the discussion. 1. The 100% Error Rate Myth According to Mr. Cohen, Medicare audits now occur every three to five years and extrapolated findings can inflate repayment demands by 10 to 50 times. Yet 85% of practic