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 […]
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 […]
Washington, D.C. – Today, The Council for Medicare Integrity (CMI) sent a letter to Department of Health & Human Services (HHS) Secretary Tom Price asking for expanded efforts to reduce improper payments within the Medicare program. Last week, the Secretary testified before the Senate Finance Committee stating, “we are absolutely committed to program integrity.” The letter urges the Secretary to bolster program integrity efforts that protect Medicare resources and discusses concerns for the financial future of the Medicare program. “With Medicare […]
Says Medicare is missing the opportunity to protect program solvency. Washington, D.C. – Recently, while testifying before the House Budget Committee regarding the current scale of government improper payments, the U.S. Comptroller General Gene Dodaro reiterated recommendations that CMS should implement a permanent Recovery Audit Contractor Prepayment Review Program. The Comptroller General said: “We recommended that CMS seek legislative authority to allow RAs to conduct prepayment claim reviews. HHS did not concur with this recommendation, stating that CMS has implemented […]
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 […]
Leveraging expertise of recovery auditors could prevent billions lost to improper billing Washington, D.C. – Today, the Council for Medicare Integrity (CMI) asked Members of Congress to champion the authorization of a prepayment Recovery Audit Contractor (RAC) Program to review Medicare Fee-For-Service (FFS) claims before they are paid to identify errors and prevent tens of billions in improper payments from draining from the program each year. Medicare loses more money to improper payments than any other program government-wide. An improper […]