# Response to Audit Findings Letter for NEMT Medicaid and Broker Audits, With Claim-by-Claim Objections

Canonical URL: https://nemtguide.com/templates/audit-response-letter/ · Updated 2026-10-30

A response to audit findings letter is your written answer to an auditor's draft report on NEMT claims already paid. List every finding you dispute, claim by claim, with the trip records that prove it, object to the sample and any projection, and send it by the deadline. In New York you get 30 days from receipt, and a later hearing covers only what you raised.

- Object to every finding you dispute in this letter. In New York, a later hearing cannot raise new matter the auditor did not consider with your objections.
- Answer each sampled claim in its own row, with the exhibit numbers that prove it, and say plainly which findings you accept.
- Ask for the sample list, the full list of claims it came from, and the sampling method before you accept a projected total.
- Send only records made at the time of the ride. Florida bars records that were not contemporaneous or not handed over when asked.
- Keep a page-by-page list of what you sent and proof of delivery. MTM Health's agreement says requested records are not returned.

An auditor has tested a sample of your paid trips and sent a draft report saying some of them were overpaid. This letter is your one full chance to answer before the findings become final. It covers a state Medicaid audit and a broker or health plan audit alike: a cover letter, a table that answers each finding, your objections to the sample, an exhibit index, and a list of every page you send.

## How to use this template

1. **Check what you received.** This template answers a draft or preliminary report on claims already paid. A denied claim that was never paid needs a [claim appeal letter](https://nemtguide.com/templates/claim-appeal-letter/) instead. A final report usually calls for payment, a payment plan, or a hearing request, each with its own deadline. See [Medicaid recoupment](https://nemtguide.com/guides/medicaid-recoupment/) for those.
2. **Mark the deadline the day the report arrives.** Write down the date printed on it and the date it reached you. New York counts 30 days from receipt and presumes receipt five days after the report's date. Texas counts 30 calendar days from receipt, or an earlier date the auditor sets. A broker's request letter gives its own date. If you need more time, ask in writing before the deadline, and count on it only once the answer is in writing.
3. **Get the sample data.** Ask the auditor in writing for the list of sampled claims, the full list of claims the sample was drawn from, and how the overpayment was projected, if it was. You need these to check that every sampled claim is yours.
4. **Pull the full record for each sampled trip.** Both legs of the trip log, the rider's signature, the authorization, proof of the medical visit, odometer or GPS miles, tolls, and the driver's and vehicle's credentials for that day. [NEMT trip documentation](https://nemtguide.com/guides/nemt-trip-documentation/) lists what a complete record holds.
5. **Sort every finding into three groups.** Findings you can prove wrong, findings you accept, and claims that are not yours or were already refunded. Fill in Part 2 for every finding, including the ones you accept, so the auditor sees you read each one.
6. **Write the cover letter in Part 1** and name one contact for the whole audit. Texas lets you designate a point of contact who gets all audit mail: send the person's details to the auditor and to the Inspector General's Sanctions unit.
7. **Number your exhibits in Part 4 and list every page in Part 5.** Send copies, never originals, and keep an identical set.
8. **Send it so you can prove when it arrived,** and record it in Part 6. Use the address, portal, or secure email the report names.
9. **Look past the sample.** If the same error happened on trips the auditor did not test, plan to refund them (see the last section).

Get a health care attorney when the amount is large, when it was projected from a sample, or when any letter mentions fraud.

## The template

### Part 1: Cover letter

[Your letterhead]

Date: ______________

To: ______________________________ (the person named in the report to receive objections, with address, portal, or secure email)

Re: Response to draft audit findings, audit number ______________

Provider: ______________ NPI: ______________ Medicaid or broker provider number: ______________

Audit period: ______________ to ______________ Auditor: ______________ Date on the draft report: ______________ Date we received it: ______________

**Our response.** This letter responds to the draft audit report dated ______________. Our response is due by ______________, counted under ______________ (the rule or contract section). We object to the findings listed in Part 2 as "Disputed" and to the sampling and calculation issues in Part 3. We accept the findings marked "Accepted."

**Summary.** The report disallows ______ of ______ sampled claims, for $______________, projected to $______________ for the audit period. We dispute ______ findings, totaling $______________ in the sample. The records attached as Exhibits ______ through ______ were made at the time of each ride and are sent in the form they were kept.

**What we ask.** Please withdraw the disputed findings, correct the sample and the projection as set out in Part 3, and send us the items requested there. If any finding is not withdrawn, please state the reason in the final report so we can address it.

**Contact.** Please send all questions and notices about this audit to ______________, ______________ (title), at ______________ (phone) and ______________ (email or address).

Signature: ______________________________ Printed name and title: ______________________________ Date: ______________

### Part 2: Claim-by-claim objections

| Sample no. | Claim ID | Date of service | Finding | Our response (one or two sentences) | Exhibits |
|---|---|---|---|---|---|
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |
| | | | | | |

Mark each response "Disputed" or "Accepted." For a disputed finding, name the fact the auditor missed and the exhibit that shows it, such as "Pickup and drop-off times are on the driver's log for both legs, Exhibit 4, page 2."

### Part 3: Sampling and calculation objections

**Sampled claims that are not ours, or that were already corrected.**

| Sample no. | Claim ID | Problem (not our claim, already refunded or adjusted, duplicate, outside the audit period) | Proof (exhibit) |
|---|---|---|---|
| | | | |
| | | | |
| | | | |

**The projection.** We object to the projection of the sample results to the audit period. Please send the sampling plan, the random numbers used, the full list of claims the sample was drawn from, the list of sampled claims, the calculation of the point estimate and confidence limit, and any certification of the sampling method. We reserve the right to answer the projection once we receive them.

**Rates and amounts.** For each finding below, the disallowed amount does not match the rate, units, or miles in effect on the date of service:

| Claim ID | Amount disallowed | Correct amount | Why (exhibit) |
|---|---|---|---|
| | | | |
| | | | |
| | | | |

### Part 4: Exhibit index

| No. | Exhibit | Claims it supports | Pages |
|---|---|---|---|
| 1 | Draft audit report and cover letter | All | |
| 2 | Our request for the sample data, and the auditor's reply | All | |
| 3 | Trip logs, both legs | | |
| 4 | Rider signatures | | |
| 5 | Trip authorizations or broker assignments | | |
| 6 | Proof of the medical visit | | |
| 7 | Odometer, GPS, or mapping records | | |
| 8 | Toll and parking receipts | | |
| 9 | Driver credentials on the dates of service | | |
| 10 | Vehicle registration, insurance, and inspection on the dates of service | | |
| 11 | Remittances, refunds, or adjustments already made | | |
| 12 | Other | | |

### Part 5: Records production cover sheet

Provider: ______________ Audit number: ______________ Date sent: ______________ Total pages: ______

| Pages | Document | Claim ID | Date of service |
|---|---|---|---|
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |
| | | | |

We certify that these are true copies of records kept in the ordinary course of business and that none was created or changed after we received notice of this audit.

Signature: ______________________________ Printed name and title: ______________________________

### Part 6: Sending record

| Date sent | How sent (portal, secure email, certified mail, courier) | Confirmation or tracking no. | Date received | Final report expected by |
|---|---|---|---|---|
| | | | | |
| | | | | |
| | | | | |

## New York OMIG audits

New York's rules spell out what this letter must contain, so they shape the template.

- **30 days, counted from receipt.** You may object to a draft audit report within 30 days of receiving it, and receipt is presumed five days after the date on the report. Mail the objections to the person named in the document sent with the report. They must detail the specific items you object to and include the documents you want considered (18 NYCRR 517.5). For its third-party insurance audits, OMIG's FAQ accepts a letter, a document, or a spreadsheet, asks you to put the audit number on your response, and says you may request an extension.
- **Answer in the protocol's terms.** OMIG posts the audit protocols its auditors use, including ones for ambulette and for taxi and livery trips (both revised July 22, 2026). Each lists the numbered reasons a claim is disallowed, such as missing or incomplete trip documentation and excessive mileage. Name the protocol item in Part 2 when you answer a finding.
- **Object to everything you dispute.** The draft report must warn that issues at a later hearing are limited to those in your objections. At the hearing, you cannot raise new matter that OMIG did not consider with your objections, and you carry the burden of showing its determination was wrong (18 NYCRR 517.5 and 519.18).
- **Projections are presumed correct.** A projection from a sampling method certified as valid is presumed accurate unless you rebut it with expert testimony or an actual accounting of every claim paid (18 NYCRR 519.18(g)). That is why Part 3 asks for the sampling data now.
- **What comes next.** OMIG may issue the final report once it has your objections, or 40 days after mailing the draft if none arrive. It must consider your objections and documents. The action takes effect no sooner than 20 days after the final report's date (18 NYCRR 517.6). A hearing request must be made in writing within 60 days of the final determination's date (18 NYCRR 519.7).

For OMIG's whole audit process, see [how to prepare for a Medicaid audit](https://nemtguide.com/guides/medicaid-audit-for-nemt/).

## Texas and Florida audits

- **Texas.** Audits by the Health and Human Services Commission's Inspector General cover at most five years. You may send documents to clear an exception until the 10th calendar day after the exit conference, or a later date the auditor sets. Your written management response, or a request for an informal appeal, must reach the Inspector General or its auditor by the 30th calendar day after you receive the draft report, or an earlier date the auditor sets. After a final report, you have 15 calendar days to ask for a hearing or a payment plan, and a payment plan request gives up your appeal of those findings (1 TAC 371.1719).
- **Florida.** The state's Medicaid agency may use sampling and project the results to all your claims. Its finding must rest on records made at the time of the service. You may not use records to contest an overpayment unless they were contemporaneous and, if requested during the audit, handed over at the time. A note added to a record made at the time can be considered only if it was added before you were told of the audit. Every document for a hearing must be exchanged at least 14 days before it (2026 Florida Statutes, 409.913(20) to (22)).

## Broker and health plan audits

A broker's audit runs under your transportation provider agreement, not a state rule, so read it before you answer. MTM Health's standard agreement, in the January 1, 2023 version Pennsylvania posts, shows the usual terms:

- **Access and deadlines.** You must allow audits, which may be unannounced, and copying of billing reports, trip logs, and other records by MTM, its client, and government officials. Missing a document request date can mean removal from the network (section 2.T).
- **Records are not returned.** MTM keeps what you send, so you must keep copies (section 2.T). Part 5 is your proof of what left the office.
- **Ten years.** You keep full records of your operations for 10 years, or longer if law or the client requires (section 2.S).
- **Offsets.** MTM may recover an overpayment by offsetting future payments, and its appeals process covers denied claims (section 6.D).

Send the response to the person and address in the broker's request, and keep its findings letter with your copy. See [NEMT broker audits](https://nemtguide.com/guides/nemt-broker-audits/) for what brokers check.

## Rules for the records you send

- **Never change or add to an old record.** Send each record as it was made, and say in Part 2 when one is missing. Florida's law on contemporaneous records, above, shows how auditors treat late additions.
- **Send rider information only to the auditor, securely.** HIPAA lets you disclose health information to a health oversight agency for audits authorized by law ([45 CFR 164.512](https://www.ecfr.gov/current/title-45/section-164.512)). When it is reasonable, you may rely on a public official's statement that the records requested are the minimum necessary ([45 CFR 164.514](https://www.ecfr.gov/current/title-45/section-164.514)). Use the portal or secure method the auditor names, and send nothing beyond the request. See [HIPAA for NEMT](https://nemtguide.com/guides/hipaa-for-nemt/).
- **Refund what you find outside the sample.** If your review shows the same error on trips the auditor did not test, federal law requires you to report and return the overpayment, with a written reason, within 60 days after you identify it ([42 U.S.C. 1320a-7k(d)](https://www.law.cornell.edu/uscode/text/42/1320a-7k)). Money kept past that deadline can become a False Claims Act obligation. See [the 60-day overpayment rule](https://nemtguide.com/guides/medicaid-overpayment-60-day-rule/).
- **Do not void claims on your own.** Ask the auditor first. In its third-party insurance audits, OMIG tells providers not to send claim voids or adjustments in response to a final audit report, and to follow its repayment instructions instead.

## Frequently asked questions

### How long do I have to respond to a draft audit report?

The report or its cover letter says. In New York, you must mail your objections within 30 days of receipt, and receipt is presumed five days after the date on the report (18 NYCRR 517.5). Texas's Inspector General must receive your written response by the 30th calendar day after you receive the draft, or an earlier date the auditor sets (1 TAC 371.1719). A broker sets its date in its request.

### Can I add a missing signature or note to a trip log now?

No. Send the record as it was made, and say plainly what is missing. Florida bases an overpayment on records made at the time of the service, considers an added note only if it was made before the audit notice, and bars records you did not hand over when asked (2026 Florida Statutes, 409.913). CMS also lists knowingly falsifying records to support claims among the for-cause reasons a state can use to end an enrollment.

### Can I object to a projected overpayment?

Yes, and do it in this letter. In New York, a projection from a sampling method certified as valid is presumed accurate unless you rebut it with expert testimony or an accounting of every claim paid, and the hearing cannot take up new matter you did not raise in your objections (18 NYCRR 519.18). Ask for the sample, the claim list it came from, and the method now.

### Should I void or rebill the claims the auditor flagged?

Not on your own. In its third-party insurance audits, OMIG tells providers not to send claim voids or adjustments in response to a final audit report and to follow its repayment instructions instead. During any audit, ask the auditor before you void, rebill, or correct any claim in the audit period. Refund errors you find outside the audit period through your state's or broker's normal process.

### Is it a HIPAA problem to send rider records to an auditor?

Not when the auditor is a health oversight agency acting under law. HIPAA lets a covered entity disclose health information to one for audits (45 CFR 164.512(d)), and you may rely on a public official's statement that the records requested are the minimum necessary (45 CFR 164.514). Send only what the request names, by the secure method the auditor gives you.

### What if my review turns up errors the auditor did not sample?

Refund them. Federal law requires a Medicaid provider to report and return an overpayment, with a written reason, within 60 days after it is identified (42 U.S.C. 1320a-7k(d)). Money kept past that date can become a False Claims Act obligation. Ask the auditor whether a refund inside the audit period should wait for the final report.

## Official resources

- [NYS OMIG: Audit protocols for ambulette and taxi or livery trips](https://omig.ny.gov/audit/audit-protocols)
- [New York: 18 NYCRR 517.5, Draft audit report](https://www.law.cornell.edu/regulations/new-york/18-NYCRR-517.5)
- [Texas: 1 TAC 371.1719, Overpayments identified in audits](https://www.law.cornell.edu/regulations/texas/1-Tex-Admin-Code-SS-371-1719)
- [Florida Statutes: section 409.913, Medicaid program integrity](https://www.flsenate.gov/Laws/Statutes/2026/409.913)
- [eCFR: 45 CFR 164.512, Disclosures for health oversight](https://www.ecfr.gov/current/title-45/section-164.512)