Category : News Coverage

Appeals court overturns ruling requiring HHS to clear Medicare appeals backlog by 2021

The U.S. Appeals Court for the District of Columbia on Friday overturned an order requiring HHS to clear its backlog of Medicare reimbursement appeals by the end of 2020. On Dec. 5, 2016, U.S. District Judge James Boasberg granted a motion for summary judgment filed by the American Hospital Association in AHA v. Burwell — a lawsuit that centers on the Recovery Audit Contractor Program. He ordered HHS to incrementally reduce the backlog of 657,955 appeals pending before the agency’s Office of Medicare Hearings and Appeals over the […]


When does a review of 0.5% make sense?

Would you feel safe flying if airlines only inspected 0.5% of their fleet of planes? What about if smoke detectors for your home were rolling off the assembly line with only 0.5% being tested to ensure that they worked to sense a fire emergency? That’s what we’re facing with payment accuracy in Medicare these days. The Centers for Medicare & Medicaid Services have drastically scaled back review of the claims providers submit to the Medicare Fee for Service program for […]

CMS Official Sidesteps Offer Of Tools To Combat Medicare Improper Pay

House Ways & Means Republicans asked CMS acting program integrity director Jonathan Morse what additional tools the agency might need to help bring down improper payment rates in Medicare — 11 percent for Medicare fee-for-service and about 10 percent for Medicare Advantage in fiscal 2016, according to the government’s payment accuracy website — but Morse did not ask for any additional authority, even though a representative from the Government Accountability Office suggested lawmakers could give CMS the authority to let […]

Mount Sinai asked to return $41.9 million in Medicare overpayments

The Office of Inspector General at HHS said Wednesday that an audit of 2012 and 2013 claims revealed that Mount Sinai Hospital did not fully comply with Medicare billing requirements. The agency audited 261 claims and found that 110 resulted in overpayments totaling at least $41.9 million for the audit period. Mount Sinai in New York City is required to do its own investigation of the problem going back six years, and refund the federal government all overpayments within 60 […]

Becker’s Hospital Review: Private sector best practices can help save Medicare

Today, more than 55 million Americans rely on Medicare for health and financial security as they age. Unfortunately, current beneficiaries, along with those who expect to enroll in the future, are unaware that the healthcare program they have long counted on to support them as they age will look much different in just 10 years – and not for the better. Medicare Trustees report that at current high spending levels and with the expected influx of new beneficiaries, the program […]


Warnings About Medicare’s Future Continue to Be Ignored

Guest Columns Warnings about Medicare’s future continue to be ignored The Government Accountability Office has released its 2017 “High Risk List,” which identifies federal agencies and programs vulnerable to fraud, waste, abuse and mismanagement. The list is published every two years at the start of a new Congress, raising the alarm about areas that greatly need attention and redirection. First designated as “high risk” back in 1990, Medicare has made the GAO list every year since due to “its size, […]


Senate committee to reintroduce bill targeting Medicare audits, appeals

A bill aimed at expediting the Medicare appeals process is expected to be reintroduced in the coming months, according to one healthcare insider. The Audit & Appeals Fairness, Integrity, and Reforms in Medicare Act, first introduced in late 2015, would add more resources to the Office of Medicare Hearing and Appeals to help combat the growing backlog of Medicare claim appeals. The original version of the bill pledged $125 million to OMHA, and $2 million to the Departmental Appeals Board […]

WBAP: Advocacy Group Offers Suggestion for Texas and its Improper Medicare Payments

Advocacy Group Offers Suggestion for Texas and its Improper Medicare Payments Posted on March 16, 2017 DALLAS (WBAP/KLIF News) — An advocacy group says it has a way to help Texas fix its improper Medicare payment problem. Leslie Paige is with the organization Citizens Against Government Waste and says hiring private auditors can do even more than hold the state accountable for what the group considers a major problem. “These private auditors identify claims that have been improperly paid, and […]

The Hill: Found: $40 billion for the federal budget

Found: $40 billion for the federal budget Discussions about the federal budget take center stage this week, sparking conversations about where to cut and where to increase funding. One important issue to consider is how we might reduce waste and improper payments in order to infuse more resources into vital programs that are struggling financially. Medicare wastes more taxpayer dollars than any other program government-wide, with more than $40 billion lost annually. It’s outrageous that the federal government allows such […]

KTSA: Report: TX Leads U.S. States In Medicare Waste

Report: TX Leads U.S. States In Medicare Waste A new report from a government watchdog group shows Texas is the biggest Medicare money waster among all of the States. “One of the big issues with Medicare is it wastes a tremendous amount of money” said Leslie Paige with Citizens Against Government Waste. California, New Jersey, Pennsylvania, and Florida rounded out the top five in the ranking of States based on how much money the group says is being wasted in […]