Why is a coding audit unlikely to identify Stark or AKS violations?

Why is a coding audit unlikely to identify Stark or AKS violations?

• A. Because coding audits always identify these violations.
• B. Because Stark and AKS violations are not detected by any audits.
• C. Because a coding audit is unlikely to identify Stark or Anti-kickback Statute violations, so the disclosure usually does not involve a code auditor.
• D. Because the violations are always identified by the billing staff.

Answer: (C)

Stark Law and Anti-Kickback Statute violations involve the legality of financial relationships and referral patterns, not how services are coded. A coding audit checks whether the codes billed match the actual services documented and whether billing practices are accurate for reimbursement. It looks for coding errors, upcoding, or unbundling, not for whether the underlying referral arrangements or compensation violate these laws. A service can be properly coded even if the referral or payment arrangement is unlawful, so coding audits often miss Stark/AKS issues. Detecting those violations requires review of contracts, ownership and compensation terms, FMV analyses, and referral practices—work typically handled by compliance or legal teams rather than code auditors.

Stark Law and Anti-Kickback Statute violations involve the legality of financial relationships and referral patterns, not how services are coded. A coding audit checks whether the codes billed match the actual services documented and whether billing practices are accurate for reimbursement. It looks for coding errors, upcoding, or unbundling, not for whether the underlying referral arrangements or compensation violate these laws. A service can be properly coded even if the referral or payment arrangement is unlawful, so coding audits often miss Stark/AKS issues. Detecting those violations requires review of contracts, ownership and compensation terms, FMV analyses, and referral practices—work typically handled by compliance or legal teams rather than code auditors.