May
09
The Centers for Medicare and Medicaid Services (CMS) has issued revised provider and supplier additional documentation request (ADR) limitations for the Medicare Recovery Audit Contractor (RAC) program. According to the guidance, which became effective April 15, 2013, Medicare RACs may request a minimum of 20 records in a 45-day period from hospitals, down from the [...]
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Apr
11
A new website, www.properpayments.org, has been launched to highlight contractor efforts to fight fraud, waste, and abuse in the nation’s healthcare programs. The website is the effort of the American Coalition for Healthcare Claims Integrity, which is made up of Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), and Medicaid Integrity Contractors (MICs). The [...]
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Apr
04
A recent House Energy and Commerce Subcommittee on Health hearing discussed fraud, waste, and abuse in Medicare and Medicaid. During the hearing Peter Budetti, Deputy Administrator and Director, Center for Program Integrity, Center for Medicare and Medicaid Services (CMS), testified about efforts to reduce improper payments. Budetti gave an overview of the Fraud Prevention System, [...]
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Apr
03
CMS has released its FY2011 RAC Report to Congress. The annual report confirms the success of the Medicare RAC program and indicates that Medicare RACs collected $797.4M in overpayments from hospitals and other providers and repaid $141.9M in underpayments. After fees, the Medicare RAC program saved Medicare more than $488M in 2011. HDI, a subsidiary [...]
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Apr
02
The sequester that went into effect March 1, 2013 will affect efforts to curb fraud, waste, and abuse in our nation’s healthcare system. According to a report by the Office of Management and Budget (OMB), $57 million has been cut from the Health Care Fraud and Abuse Control Program (HCFAC), which is designed to coordinate [...]
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Mar
28
Earlier this year the Department of Health and Human Services (HHS) and Department of Justice (DOJ) released the FY2012 Health Care Fraud and Abuse Control Program (HCFAC) report. The report indicates that the government’s healthcare fraud prevention and enforcement efforts recovered $4.2 billion in taxpayer dollars in FY2012. The number is the highest annual amount [...]
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Feb
12
The Department of Health and Human Services (HHS) Office of Inspector General (OIG) released a report in January indicating that Medicaid third party liability (TPL) savings have increased since 2001. Specifically, state efforts have increased cost avoidance and pay-and-chase savings from $34 billion in 2001 to $72 billion in 2011. Many states attributed increased savings [...]
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Jan
29
Members of the National Governors Association spoke recently about broad policy changes facing states in 2013 — including healthcare. Some governors are hoping the federal government will be flexible and allow states to submit their own innovative solutions to healthcare reform implementation. Others acknowledged that a one-size-fits-all approach would not be appropriate and encouraged states [...]
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Jan
10
Section 6411 of the Affordable Care Act (ACA) requires states to partner with Medicaid Recovery Audit Contractors (RACs) to identify overpayments and underpayments by the state Medicaid agency; recoup overpayments; create processes for appealing adverse determinations; and coordinate recovery efforts with other entities. As of November, 34 states have awarded Medicaid RAC contracts and 11 [...]
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Jan
03
The Centers for Medicare and Medicaid Services (CMS) has released guidance that indicates that states cannot expand their Medicaid programs to less than 133% of the federal poverty level (FPL) and still receive 100% federal matching funds that are available from 2014 through 2016. If states decline to expand coverage to 133% FPL but would [...]
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