You’ve Got to be Kidding. . . More Medicare Audits on the Way?

March 11, 2010 by  
Filed under Featured, Medicare Audits

(March 11, 2010): According to the White House, President Obama has announced that he intends to back bipartisan plans to stamp out waste in government-run medical programs for the elderly and needy.  The White House said the new effort to root out improper payments in the Medicare and Medicaid programs could double taxpayer savings over the next three years to at least $2 billion.

“We cannot afford nor should we tolerate this waste of taxpayer dollars,” the White House said.   The government believes that approximately $54 billion was lost through improper Medicare and Medicaid payments in 2009. Medicare is the government-run program covering elderly Americans and Medicaid is for the country’s poorest.

President Obama is seeking to crack down on waste and fraud as his administration strives to secure an overhaul of the $2.5 trillion healthcare system to contain costs and expand coverage to tens of millions of more Americans.  The action endorses Republican-backed proposals on alleged health care wrongdoers.

The plan will offer private auditors a share of the money that they recoup in order to encourage them to work harder to uncover improper payments under Medicare and Medicaid.   President Obama is also expected to back bipartisan legislation to expand the ability of government agencies to undertake these so-called payment recapture audits by providing more funds.

As many owners and managers will readily attest, CMHCs appear to have been targeted by PSCs and ZPICs in past audit initiatives.  Once again, this points to the importance of sefl-assessment and an effective compliance strategy.  Asked to comment on this new “risk” to CMHCs, Robert W. Liles, Esq., Managing Partner at Liles Parker, Attorneys and Counselors at Law, responded:

 ”Our firm has represented a number of CMHCs and has analyzed various approaches to documenting partial hospitalization program services.  While approaches vary from client to client, the CMHCs we have assessed have clearly endeavored to comply with applicable LCD documentation requirements.  Unfortunately, PSCs and ZPICs appear to be implementing their own views regarding what is required, well beyond the four corners of the CMS-authorized provisions set out under the LCD.  Fortunately, when faced with the facts, ALJs have applied a reasonable approach and most of the claims at issue have been found to be payable.  We strongly recommend that CMHCs review their documentation practices to lessen the likelihood that ZPICs and other third-party reviewers will be able to argue that the claims don’t qualify for coverage.”

Should you have any questions regarding these changes, don’t hesitate to contact us.  For a complementary consultation, you may call Robert W. Liles or one of our other attorneys at 1 (800) 475-1906.