Medicare, Medicaid & Private Payor Updates

GAO Testimony Recommends CMS Improve Enrollment, Payment, and Oversight Procedures

Medicare, Medicaid & Private Payor Updates /

(June 23, 2010): Yesterday we told you about recent GAO testimony before Congress regarding the impact of health care reform on HHS enforcement efforts. On the same day, GAO Health Care Director Kathleen M. King offered Congress testimony that made clear that the Centers for Medicare & Medicaid Services (CMS) continue to face substantial challenges […]

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President Obama Publicizes Measures to Reduce Medicare Improper Payment Rate

Medicare, Medicaid & Private Payor Updates /

(June 8, 2010): For those of you who missed the first two dozen pronouncements (okay, perhaps a little exaggerated, but still . . . we got the message when Congress made it a False Claims Act violation to hold onto a mere overpayment for more than 60 days), President Barack Obama has again expressed his

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Responding to a Search Warrant Executed at Your Health Care Practice or Clinic

Medicare, Medicaid & Private Payor Updates /

(June 1, 2010): Like most honest health care providers, you may believe that search warrants are only executed by the government in connection with the investigation of nefarious characters and criminals. Unfortunately, that just isn’t the case. The Federal government has increasingly utilized search warrants as a first-strike investigative tool. In fact, the execution of

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HHS-OIG Reports that Four Medicaid Audit Error Types Accounted For 95% of the Net Improper Medicaid Overpayments

Medicare, Medicaid & Private Payor Updates /

(April 20, 2010): The Department of Health and Human Services, Office of Inspector General (OIG) recently released its report on Medicaid Audits “HHS-Analysis of Improper Payments Identified During the Payment Error Rate Measurement Program Reviews in 2006 and 2007 (A-06-09-00079).” As set out in the report, four types of medical review errors accounted for 95%

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Your Next “Patient” May be an Undercover Secret Shopper Performing a Medicare Audit on Your Practice.

Medicare, Medicaid & Private Payor Updates /

(April 10, 2010): As the American Medical Association (AMA) recently reported on March 22nd, 2010, health care providers may find themselves subjected to a Medicare Secret Shopper audit by fellow health care providers and others hired by the government to conduct undercover reviews and investigations. In a speech he made March 10th, 2010, President Obama

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HEAT Strike Force Update: Prosecutions in Texas Increased in March 2010

HEAT Strike Force, Regulatory Issues | Privacy | Other /

(April 3, 2010): The Federal government is taking considerable steps to stop Medicare fraud and abuse. Notably, the number of publicly-disclosed HEAT Strike Force investigations and prosecutions in Texas significantly increased last month. Two of the cases disclosed involved mental health professionals: A Psychologist was convicted of health care fraud and money laundering, in connection

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For AdvanceMed, it’s Not Personal, Just Business – Big Business

Medicare, Medicaid & Private Payor Updates /

(March 26, 2010): Over the next few days, we will be publishing a brief overview of specific Zone Program Integrity Contractors (ZPICs) (such as AdvanceMed) – the companies who have been hired by CMS to conduct the medical reviews of Part A and Part B health care providers around the country. As we have previously

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Will Another Bounty Hunter Be Conducting Medicare Audits?

Medicare, Medicaid & Private Payor Updates /

(March 25, 2010): Yesterday, the White House announced that President Obama intends to back additional bipartisan plans to stamp out waste in government-run medical programs for the elderly and needy. The White House said this new effort, which is being called nothing more than another bounty hunter program by its critics, is intended to root

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Is a ZPIC Tougher than a RAC or PSC When Conducting Medicare Audits?

Medicare, Medicaid & Private Payor Updates /

(March 25, 2010): The Recovery Audit Contractor (RAC) program is an integral part of the Centers for Medicare & Medicaid Services’ (CMS’) “benefit integrity” efforts which seek to identify and recoup alleged overpayments paid to Medicare providers. Similarly, Program SafeGuard Contractors (PSCs) have been actively auditing Medicare providers and suppliers around the country. While the

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