Medicare, Medicaid & Private Payor Updates

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

(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% of the …

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

(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 expressed interest in …

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

(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, …

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

(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?

(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 out …

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

(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 RAC program …

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Texas ZPIC Audits in Texas are Increasing – Is There a New Sheriff in Town?

(March 16, 2010): Health care providers around the country are finding themselves the target of various audits from jurisdictionally overlapping Medicare contractors.  Notably, any of these audits have the potential to destroy a provider’s practice or clinic.  States where PSCs (Program Safeguard Contractors) have transitioned to ZPICs (Zone Program Integrity Contractors) are under extreme pressure. …

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