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The Hill: Feud between hospitals, Medicare contractors explodes over fraud bill

  Recovery audit contractors are pushing back on new legislation that weakens oversight of Medicare payments. FROM THE HILL:  RACs charge that the new bill from Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) will severely undercut their efforts to secure Medicare’s finances at a time when improper payments are rife within the program. A spokeswoman for the American Coalition for Healthcare Claims Integrity, a nonprofit coalition, pointed to more than $2 billion recovered for Medicare by RACs in 2012. […]

CBS: U.S. Attorney’s Office Sees Uptick in Health Care Fraud Cases

  In this video, the U.S. Attorney’s Office reports that healthcare schemes previously uncovered in Miami are now on the rise in West Michigan. FROM CBS NEWS GRAND RAPIDS, MI: “In fiscal year 2012, the Department of Justice recovered $3 billion of taxpayer money by cracking down on health care fraud. “Taxpayers are definitely the ultimate victim here, and that means everyone is suffering when people are abusing the system,” said U.S. Attorney Pat Miles. We’re told that schemes that […]

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FBI: Medical Equipment Company Owner Arrested in 21-Count Health Care Fraud Indictment

  Authorities arrested Andrea Michelle Tellison, owner of Texas Durable Medical Company, following a 21-count indictment charging her with healthcare fraud and aggravated identity theft. From the FBI Website: Durable Medical Equipment Company Owner Arrested in 21-Count Health Care Fraud Indictment HOUSTON—Andrea Michelle Tellison, 46, has been arrested following the return of a 21-count indictment charging her with health care fraud and aggravated identity theft, United States Attorney Kenneth Magidson announced today. The indictment was returned under seal Wednesday, March 20, […]

RACMonitor: Fallout Continues over Audit Reform Bill

  The Medicare audit reform bill, introduced by Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), will weaken the federal government’s flagship healthcare program. FROM RACMonitor:  “Every year, more than $65 billion in improper payments are made to healthcare providers due to fraud, waste, abuse, and billing errors,” Amanda Keating, a spokesperson for the American Coalition for Healthcare Claims Integrity, said in a written statement to RACmonitor. “This puts a tremendous burden on a Medicare system already struggling to remain […]

POLITICO Pulse: Medicare Fraud Proposal Takes Lumps From Defenders of Contractors

  POLITICO Pulse exposes the special interests driving RAC reform efforts in the House. FROM POLITICO PULSE:  It didn’t take long for the bipartisan harmony presented by the sponsors of the Medicare Audit Improvement Act to devolve into a mud fight. Primary sponsors, Rep. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.), presented the bill as an effort to ease the administrative burden on small hospitals by restricting Medicare fraud contractors’ ability to make onerous document requests. But a chorus of […]

The Hill: Bill seeks to ease Medicare audit burden

  Reps. Sam Graves (R-Mo.) and Adman Schiff (D-Calif.) have introduced new legislation to limit auditing activities within a certain timeframe. FROM THE HILL’s HEALTHWATCH: The measure would limit the number of “additional document requests” to two percent of hospitals claims, with a maximum of 500 per 45 days. It would also penalize auditors that ignore basic audit requirements and courtesies. A non-profit anti-fraud group criticized the bill. “While we have not had an opportunity to review the legislation in […]

Coalition: Legislation Will Limit Programs that Fight Waste, Fraud and Abuse in Medicare

  FOR IMMEDIATE RELEASE March 12, 2013 Coalition: Legislation Will Limit Programs that Fight Waste, Fraud and Abuse in Medicare Bill seeks to curtail the ability of auditors to carry out highly effective waste, fraud and abuse prevention programs Washington, D.C. – The American Coalition for Healthcare Claims Integrity (ACHCI) issued the following statement regarding new legislation introduced today by Rep. Sam Graves (R-MO) and Rep. Adam Schiff (D-CA) that aims to limit the number of documents that recovery auditors […]

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FBI: Houston-Area Doctor Sentenced for Role in $17.3M Medicare Scheme

  From the FBI Website: Houston-Area Doctor Sentenced to 63 Months in Prison for Role in $17.3 Million Medicare Fraud Scheme WASHINGTON—A Texas doctor was sentenced today to serve 63 months in prison for conspiring to commit health care fraud by falsifying plans of care for Medicare beneficiaries, including patients whom he did not treat, as part of a $17.3 million Medicare fraud scheme. Today’s sentence was announced by Acting Assistant Attorney General Mythili Raman of the Justice Department’s Criminal Division; U.S. Attorney […]

POLITICO Pulse: Healthcare Group to Congress: Don’t Cut Fraud Programs

  POLITICO Pulse examined ACHCI’s effort to prevent Congress from restructuring vital healthcare auditing programs. FROM POLITICO PULSE:  The American Coalition for Healthcare Claims Integrity is asking Congress not to pass legislation that would hurt programs targeting health care fraud and waste — noting that provisions in the health care law have recovered $10.7 billion since 2009, mostly improper payments in Medicare and Medicaid. “Our coalition members have a proven track record of helping return significant funds to government health […]

Washington Post: Federal Government Continues to Lose Billions to Waste, Fraud and Abuse

  In this story, the Washington Post reports that the federal government lost $261 billion, or 7 percent of total spending, to fraud and waste in 2012. FROM THE WASHINGTON POST: “Despite progress in reducing improper payments, federal agencies continue to lose billions annually to waste, fraud and abuse. The federal government lost $261 billion, or 7 percent of total spending, to fraud and waste in 2012, said Rep. Darrell Issa (R-Calif.) during a February House committee hearing. Though improper […]