Medicare Audits and Participating in Medicare --> Re: CMA on concierge medcine

[Guest guest]

Matt,

 

Is it paranoia when they really ARE after you?  :-)

 

I agree that they probably go after the big fish - but with the expansions below and the ability to start crunching #'s electronically - I, too, worry about getting audited.

 

http://www.ama-assn.org/amednews/2010/03/22/gvsa0322.htm

Medicare audits to be expanded

Obama directs all federal agencies to intensify claims review in a fraud-fighting effort. A separate proposal for physicians to pose as patients prompts AMA concerns.

By Silva, amednews staff. Posted March 22, 2010.

snip/snip

 

Some physicians already have experience with these types of reviews. The Medicare recovery audit contractor program was pilot-tested in three states -- California, Florida and New York -- from 2005 to 2008. During the last year of the pilot, CMS expanded it to Massachusetts and South Carolina. Its claims reviews resulted in the program recapturing nearly $1 billion for taxpayers that the RACs found Medicare had overpaid or had otherwise paid out inappropriately.

 

snip/snip

 

Congressional legislation enacted in 2006 already has directed the Centers for Medicare & Medicaid Services to have permanent RACs in place by 2010 to review Medicare claims from all 50 states. The agency did not respond to repeated requests for comment by this article's deadline. Obama projected that payment recapture audits would return at least $2 billion in taxpayer money over the next three years -- double the current amount of projected recovered costs from efforts targeting waste, fraud and abuse.

snip/snip

A 2008 report by CMS on the three-year RAC pilot said that only about $20 million in overpayments was recovered by auditors looking at physician claims. The vast majority of recoveries came from hospitals. But physician practices that were audited still had to devote time and resources to comply, which some complained should have been spent on patient care. Because the auditors are paid based on how much money they return to federal coffers, the firms involved were characterized by some physicians as " bounty hunters. "

snip/snip

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http://homecaremag.com/operations/billing_reimburse/obama-fraud-push-20100315/

Last week, the president issued a memorandum calling on executive departments and agencies to step up efforts to recapture improper payments by pairing highly skilled accounting specialists and fraud examiners with state-of-the-art technology to identify suspicious claims patterns. The bounty hunter techies' pay would be tied to whatever they recouped.

And therein lies a big problem, according to Gorski. " The incentive is for the bounty hunter to review as many claims as possible and unduly burden providers or trip them up with technicalities, " he said.

Many HME providers are already complaining that they are being inundated with requests from Medicare's RAC, CERT and ZPIC audit contractors for further documentation that, in some cases, can reach 50 pages per claim (see ZPIC Audits Cripple Miami Provider).

Gorski said he is concerned providers could find themselves trying to address frivolous requests that drain business resources.

" The bounty hunter should be held accountable if their requests are frivolous, " he said. " The provider has to put all that time and energy into developing the information the government wants. This should be a two-way street if that's the direction. "

Locke, MD

 

I think you're alittle paranoid about this... Medicare audits always go after high claimers like academic hospitals, etc.

 

Look at your payors and demographics.

 

Look at the " hoops " you have to jump through to maintain a practice.

 

Are you coming to Denver for IMP conference in Oct?

 

Matt in Western PA