list of healthcare providers that have been banned from participation in Medicare, Medicaid

list of healthcare providers that have been banned from participation in Medicare, Medicaid

Tuesday, September 15, 2015

Did you know that the Office of Inspector General (OIG) publishes a list of over 125,000 healthcare providers that have been banned from participation in Medicare, Medicaid, etc.? Exclusions are based on conviction of program-related crimes, healthcare fraud, patient neglect/abuse, controlled substance conviction and more. Read More

Read more
Recovery auditing in Medicare for fiscal year 2013

Recovery auditing in Medicare for fiscal year 2013

Tuesday, September 15, 2015

Did you know that the Center for Medicare & Medicaid Services (CMS) enlists the help of outside Recovery Audit Contractors (RAC’s) to identify and correct improper payments that have occurred? For FY2013, this resulted in the correction of over 1.5 million underpayments and overpayments, and returned in excess of $3.0 billion to the Medicare Trust Fund....

Read more
Comprehensive Error Rate Testing

Comprehensive Error Rate Testing

Tuesday, September 15, 2015

Did you know that Medicare’s improper payment rate is calculated annually via the Comprehensive Error Rate Testing (CERT) program? Each year, CERT evaluates a statistically valid random sample of claims to determine if they were paid properly under Medicare coverage, coding, and billing rules. For the twelve months ending June 30, 2013, the overall error rate was 12.7% amounting to $45.8 billion in improper payments. This is up significantly from the prior year rate of 10.1%....

Read more
The $272 billion swindle

The $272 billion swindle

Tuesday, September 15, 2015

Did you know that certain areas of the country are a “hotbed” of fraudulent medical billing, including such places as Miami, New York City, Detroit, Houston, Los Angeles, Tampa, and Baton Rouge? Organized crime in these regions systematically target & exploit control weaknesses in healthcare reimbursement systems, particularly Medicare....

Read more
Doctors make millions off of Medicare

Doctors make millions off of Medicare

Tuesday, September 15, 2015

Did you know that the Center for Medicare & Medicaid Services (CMS) released data in April showing the summary of payments made by Medicare to 880,000 physicians nationwide? This data has been used to identify providers with patterns of suspect or even potentially fraudulent billing. One ophthalmologist from West Palm Beach, FL collected nearly $21 million, while a cardiologist in Ocala, FL received $18 million in 2012. Seven doctors pulled in excess of $10 million....

Read more
Medicare overpaid docs billions for office visits, OIG says

Medicare overpaid docs billions for office visits, OIG says

Tuesday, September 15, 2015

Did you know that according to the Health & Human Services Office of Inspector General, Medicare overpaid physicians $6.7 billion for evaluation and management services in 2010? The overpayments were caused primarily by incorrect medical coding and inadequate documentation. This represented more than one-fifth of overall payments issued for E/M services that year.Read More...

Read more
APNewsBreak: Medicare bought meds for dead people

APNewsBreak: Medicare bought meds for dead people

Tuesday, September 15, 2015

Did you know that Medicare’s operating rules allow it to pay for prescription drugs up to 32 days after a patient’s death – not a best practice? About 80% of these prescriptions were filled at neighborhood pharmacies, reflecting criminals acquiring the drugs to presumably sell on the black market at a hefty profit. High-priced drugs tend to be painkillers and anti-anxiety drugs that are sought by people with substance-abuse issues....

Read more
How doctors and hospitals have collected billions in questionable Medicare fees

How doctors and hospitals have collected billions in questionable Medicare fees

Tuesday, September 15, 2015

Did you know that Medicare compares each doctors’ proportion of various types of office visits (new patient encounter, established patient, etc.) to determine if they conform to the national profile for all providers? If they do not conform to the typical percentages, the medical providers could be at higher risk for being audited and sanctioned for “upcoding”. This is the practice of charging patients more for the office visit than is merited based upon the documented medical treatme...

Read more
National Correct Coding Initiative Edits

National Correct Coding Initiative Edits

Tuesday, September 15, 2015

Did you know that the National Correct Coding Initiative (NCCI) is intended to promote national correct coding methodologies and to minimize improper coding leading to inappropriate payment? These coding policies were developed jointly by CMS and the American Medical Association's, and are updated annually to ensure the latest “best practices” are reflected. While originally developed for Medicare/Medicaid, it is used by many private payers to ensure proper & accurate coding and paym...

Read more
Feds recovered $3.3 billion in healthcare fraud for 2014

Feds recovered $3.3 billion in healthcare fraud for 2014

Tuesday, September 15, 2015

Did you know that the federal government recovered $3.3 billion in healthcare fraud in fiscal 2014 per the Justice Department? This amounts to $7.70 for every dollar spent on healthcare-related fraud and abuse investigations over the last 3 years. In all, 734 defendants were convicted of healthcare fraud-related crimes last year. ...

Read more