Richard Pecore

Exclusion Screening Enforcement Actions by OIG are Increasing.

(December 8, 2015): Since the passage of the Patient Protection and Affordable Care Act of March 2010[1] (ACA) and progeny such as the HITECH Act [2], enforcement efforts have been better funded and consequently, better staffed. The enactment of HIPAA in 1996 [3] and the Balanced Budget Act (BBA) of 1997 [4], further expanded the …

Exclusion Screening Enforcement Actions by OIG are Increasing. Read More »

Medicaid RACs to Increase Enforcement Efforts

(May 23, 2012): Recent efforts by CMS to improve Medicaid audit performance have resulted in procedural changes for Medicaid Integrity Contractors (MICs) and financial incentives for Medicaid Recovery Audit Contractors (Medicaid RACs) to increase their audit efforts and effectiveness. RACs have long been regarded as “bounty hunters” within the Medicare/Medicaid and healthcare provider communities. These entities …

Medicaid RACs to Increase Enforcement Efforts Read More »

Medicaid MIC Audits to Increase

(May 15, 2012): Recent efforts by CMS to improve the performance of Medicaid MIC audits have resulted in procedural changes for these contractors and new financial incentives for Medicaid Recovery Audit Contractors (MRACs).  These new procedural changes are intended to improve the effectiveness of MRAC audits.  The recent U.S. Department of Health and Human Services (HHS) …

Medicaid MIC Audits to Increase Read More »