(April 8, 2010): On Wednesday evening, April 7, Robert W. Liles, Managing Member of the Firm, met with Congressman John Culberson and a group of state and local medical association executives to discuss the recent passage of the health care reform bill. Congressman Culberson heard from the participants, noting their views of how this legislation is going to impact Texas physicians and hospitals. Mr. Liles discussed several provisions of the bill aimed at increasing health care fraud enforcement efforts. He also discussed the current ZPIC audits being conducted in Texas by Health Integrity, a Medicare contractor. The event was held at the Harris County Medical Society's headquarters in downtown Houston.
Providers were understandably worried about the situation at hand. The Federal government's recent emphasis on combating health care fraud and abuse - establishing nationwide RACs, ZPICs and HEAT teams in just the past year - has left hospitals, physicians and other health care providers in a state of panic. Audits of Medicare and Medicaid claims have been ramped up significantly, while Medicare reimbursement rates have been cut. While the deck seems stacked against health care providers, remember that providers themselves have a number of important rights under existing statutes, including rights for appealing denied claims. In this new environment though, it is imperative that health care providers accurately and appropriately document their services and that they use experienced and trained billers to process their Medicare claims.