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Inside Health Policy: Court Dismisses AHA Lawsuit — Says Congress & HHS Should Fix Appeals Backlogs, Not Courts

FROM INSIDE HEALTH POLICY: The federal DC District Court dismissed the American Hospital Association’s lawsuit to compel HHS to turn around Medicare appeals decisions on time — within 90 days at the third level of appeals — and ruled that Congress and HHS should solve the problem, not the courts. The AHA said it plans to appeal the dismissal. US District Court Judge James Boasberg said he sympathizes with the hospitals but it’s not his place to intervene. “In the […]

Modern Healthcare: Recovery Audit Lawsuit Dismissed by Federal Judge

FROM MODERN HEALTHCARE: A U.S. District Court judge has dismissed a lawsuit by hospitals seeking to compel HHS to meet statutory timelines for processing appeals to recovery audits. The American Hospital Association said in a statement that it disagrees with the court’s decision and expects to file an appeal. “While the court itself recognizes that hospitals simply cannot afford to have billions of dollars that are needed for patient care tied up indefinitely in the appeals process, its decision means […]

Inside CMS: Spending Bill Bashes RACs, Hits CMS and OMHA Over Appeals Backlog

FROM INSIDE CMS: Lawmakers in their report accompanying the recently passed fiscal 2015 spending bill blast CMS’ Recovery Audit contractor program for harming providers and contributing to the backlog at the third level of Medicare appeals. But the American Coalition for Healthcare Claims Integrity, which represents RACs, slammed appropriators for being sympathetic to providers, who the RACs allege are incorrectly billing Medicare, and say the report amounts to the hospital industry using lawmakers to bully CMS over the RAC program. […]

Coalition: Omnibus Bill Too ‘Sympathetic’ to Industry Responsible for Billions in Medicare Waste

FOR IMMEDIATE RELEASE: December 15, 2014 CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995 Washington, D.C. – The American Coalition for Healthcare Claims Integrity (ACHCI) issued a statement today regarding provisions in the Omnibus spending package that pertain to Recovery Audit Contractors and improvements to the ALJ hearing backlog. “Our coalition is pleased to see language in the omnibus spending package that calls for greater transparency and a consistent application of Medicare policy in the appeals process. While Recovery Auditors maintain a […]

Wall Street Journal: Medicare Overbilling Probes Run Into Political Pressure

Despite efforts to combat waste and abuse of taxpayer funds, providers use members of Congress to keep Medicare money coming. FROM THE WALL STREET JOURNAL: When investigators suspected that Houston’s Riverside General Hospital had filed Medicare claims for patients who weren’t treated, they moved to block all payments to the facility. Then politics intervened. Rep. Sheila Jackson Lee, a Texas Democrat, contacted the federal official who oversees Medicare, Marilyn Tavenner, asking her to back down, according to documents reviewed by […]

Inside Health Policy: RACs Ask To Be More Involved In ALJ Appeals

  Recovery Audit contractors want to be more involved at the ALJ appeal level to help speed up the process and cut back the growing backlog of appeals. FROM INSIDE HEALTH POLICY: Recovery Audit contractors say they should be more involved in the Medicare appeals process, and they say those involved with appeals should be notified about hearings. The Office of Medicare Hearings and Appeals recently requested suggestions for reducing the backlog of appeals at the Administrative Law Judge level […]

Wall Street Journal: New Medicare Rules Aim to Reduce Abuse

  The Obama administration has enabled the Centers for Medicare and Medicaid Services to take direct action to kick doctors out of the Medicare program for abusive billing practices. FROM THE WALL STREET JOURNAL: The Obama administration on Wednesday strengthened Medicare’s authority to kick doctors and other medical providers out of the federal program for abusively billing the government. The move represents a significant shift in how the government tackles waste in Medicare, the insurance program for the elderly and […]

American Action Forum Release RAC Program Primer

  The American Action Forum, a Washington-based policy institute, released a primer today that provides a valuable introduction to the Recovery Audit program, the “Two-Midnight” rule, and the issues surrounding Medicare integrity. Read the primer on the here, at the AAF website.

Medicare FFS Error Rate Continues To Increase In Fiscal 2014

  As the RAC moratorium continues, the Medicare fee-for-service error rate has climbed to the highest rate in history. Read more from Inside Health Policy: FROM INSIDE HEALTH POLICY: The Medicare fee-for-service improper payment rate rose again in fiscal 2014, to almost 13 percent, according to a report recently released by HHS, and Recovery Audit Contractors point out that the increase coincides with CMS’ decision to pause the RACs and limit what audits they could conduct. The HHS FY 2014 […]

Medicare Improper Payment Rate Continues To Climb, Recoveries Decline As RACs Are Sidelined

FOR IMMEDIATE RELEASE November 24, 2014 CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995 Medicare Improper Payment Rate Continues To Climb, Recoveries Decline As RACs Are Sidelined The FY2014 Medicare FFS program improper payment rate is now 12.7%, representing a $46.0 billion annual loss to the program Washington, D.C. – The Centers for Medicare and Medicaid Services (CMS) have released the Medicare fee-for-service Recovery Audit Program’s annual report to Congress for the fiscal year 2013. The report shares that during that year Recovery Audit […]