Report: Pennsylvania on list for high Medicare waste
HARRISBURG, Pa. — A report from the Council for Medicare Integrity states Pennsylvania is one of the top five states with Medicare waste.
According to the numbers citing data from the Center for Medicare and Medicaid Services FY 2013 RAC Report to Congress, California has about $517,000,000 in over payments from Medicare. Pennsylvania ranks fifth with $153,000,000; a million dollars more than Texas.
At a hearing this morning in Washington D.C., Gary Cantrall, an investigator with the Office of Inspector General said annual Medicare spending is expected to be $600 billion. As the program grows, protection has never been more important, suggested Cantrall.
A few years ago, Congress created a Recovery Audit Contractor program to review post-payment Medicare-claims and make sure it is accurate. “It’s not abuse. It’s not fraud,” said Paula Sanders, a lawyer who represents health care providers on the financial waste. “We could probably be a little bit more about our documentation by and large.”
Errors, said Sanders, can make a difference for Medicare to cover something because if documentation isn’t correct it could appear the money would have been wasted. Missing signatures and missing dates on forms could be cause to deny a Medicare claim, according to Sanders.
“The rules are very complex and it’s very hard to make sure you’re providing the best care you can,” said Sanders who showed one regulation for medical billing was outlined in a handful of books.
According to a report from the Office of Inspector General, some hospitals in Pennsylvania were recommended to pay back overpayments discovered after errors.
In a statement by the Hospital and Healthcare Systems Association of Pennsylvania, a spokesman wrote in part, “Hospitals want to bill and be paid accurately the first time. A single recovery audit contractor can produce dozens of payment denials per day. While hospitals appeal every incorrect denial through a lengthy and expensive two-or-more-years one claim at a time.”
Federal law requires the Centers For Medicare and Medicaid to try and recover all over payments they discover.
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