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LifeHealthPro: Medicare claim auditors blast hospital protection bills

    The Senate has introduced a bill that would greatly impair the work of recovery audit contractors and weaken the Medicare program overall. FROM LIFEHEALTHPRO: The bill also would set new standards for claim recovery audit contractors, direct the HHS secretary to publish recovery audit contract performance information on the Web, and require that a physician review any claim that a billed service was not medically necessary. The American Coalition for Healthcare Claims Integrity — a group of recovery […]

McKnight’s: RACs push back against audit improvement bills

  Last month, the Senate introduced a bill seeking to limit Medicare auditing activities. In response, our coalition is ramping up efforts to preserve vital recovery initiatives and reinforce Medicare integrity. FROM MCKNIGHT’S: The Medicare Audit Improvement Act of 2013 was introduced in the House of Representatives in March. A Senate version of the bill was introduced last month. The bill would rein in auditors and improve transparency, which have been provider concerns. The goal is for less redundant audits, less burdensome […]

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

FOR IMMEDIATE RELEASE June 3, 2013 Legislation Limits Programs that Fight Waste, Fraud and Abuse in Medicare Senate and House legislation works 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 the introduction of companion legislation in the Senate (S. 1012) that would undermine the efficacy of the highly-effective recovery audit contractors that work with the Medicare […]

Salon: Medicare funding cosmetic surgery boom

  Taxpayers paid $80 million toward eyelid-lift surgeries in 2011, the result of a dramatic uptick in cosmetic eye procedures dubbed “medically necessary” and billed to Medicare. FROM SALON: Yes, Medicare. The public health insurance program for people over 65 typically does not cover cosmetic surgery, but for cases in which a patient’s sagging eyelids significantly hinder their vision, it does pay to have them lifted. In recent years, though, a rapid rise in the number of so-called functional eyelid […]

Coalition: CMS’ Proposed Rule Disincentivizes Providers to Bill Medicare Properly and Accurately

  FOR IMMEDIATE RELEASE May 17, 2013 Coalition: CMS’ Proposed Rule Disincentivizes Providers to Bill Medicare Properly and Accurately Rule threatens Medicare beneficiaries and Trust Fund solvency with ‘endless loop of rebilling’ Washington, D.C. – The American Coalition for Healthcare Claims Integrity (ACHCI) today issued the following statement from spokesperson Becky Reeves after submitting comments to CMS on the Medicare Part B Inpatient Billing in Hospitals proposed rule (CMS-1455-P). “After carefully reviewing the proposed rule, we are gravely concerned about […]

U.S. Dept. of Justice: Medicare Fraud Strike Force Charges 89 Individuals for Approximately $223 Million in False Billing

  Attorney General Eric Holder and Department of Health and Human Services Secretary Kathleen Sebelius announced a nationwide takedown of fraudulent healthcare providers, involving 89 individuals who were responsible for $223 million in false billings across eight cities. FROM THE DEPT. OF JUSTICE: The defendants charged are accused of various health care fraud-related crimes, including conspiracy to commit health care fraud, violations of the anti-kickback statutes and money laundering.  The charges are based on a variety of alleged fraud schemes involving various […]

Modern Healthcare: Unusual billing patterns spur probe of inpatient hospice care

  The Office of the Inspector General has launched a sweeping investigation of the $1.1 billion hospice industry, following the discovery of Medicare fraud at the largest for-profit hospice care company in the U.S., Vitas Healthcare Corp. FROM MODERN HEALTHCARE: The hospices that provided inpatient care in their own units recorded 50% longer patient stays and three times the proportion of Medicare revenue for those services than those that sent hospice clients outside for inpatient care. Medicare paid providers a […]

BROWARD NEW TIMES: Medicare Fraud is Sweetest Crime in South Florida

  Medical businesses located in strip malls have become hotspots for Medicare fraud in South Florida. FROM BROWARD NEW TIMES: “Driving through Hialeah, where strip malls line boulevards like concrete-and-metal kudzu, a federal agent offers a reporter $1 for every strip mall he can spot that doesn’t house a medical business. Let’s just say the reporter is still broke. In this city, streets are a jumble of doctors’ offices, physical therapy programs, adult daycares, and mental-health clinics stretching in every […]

HOUSTON PRESS: Thieves’ Bazaar: Medicare Fraud

  Houston Riverside General hospital payed “recruiters” $300 per head to transport patients to unnecessary therapy sessions, billing Medicare for the $116 million in fraudulent costs. FROM THE HOUSTON PRESS: “It wasn’t until 2011 — 15 years after the initial accusations — that law enforcement got serious. That’s when the feds nailed administrator Mohammad Khan, who confessed to enriching the hospital through a kickback scheme. He’d been paying “recruiters” $300 a head to bring Medicare patients to Riverside’s six psychiatric clinics. […]

ABC NEWS: 6 Arrested in Sacred Heart Hospital Fraud Investigation

  The owner of Sacred Heart Hospital, a hospital executive, and four doctors are accused of billing Medicare and Medicaid for unnecessary medical treatments. FROM ABC NEWS CHICAGO: “Federal agents on Tuesday were looking beyond the case already filed for evidence of unnecessary medical procedures — paid for by the Medicare and Medicaid programs — that include intubations and tracheotomies. “Which as you know are procedures which involved inserting a tube into the patient’s windpipe or actually surgically cutting a […]