On July 28, 2011, the House Oversight and Government Reform Committee held a hearing on Improper Medicare Payments. The hearing highlights the ongoing friction between providers and recovery audit contractors (RACs) and the fact that the Centers for Medicare and Medicaid Services (CMS) is continuing their effort to combat fraud through such efforts as pre-enrollment […]
On July 21, 2011, the Office of Inspector General (OIG) of the Department of Health & Human Services (HHS) announced that Administrative Law Judge (ALJ) Steven T. Kessel upheld OIG’s exclusion of Michael D. Dinkel from participation in all Federal health care programs under section 1128(b)(7) of the Social Security Act for a period of […]
On Capitol Hill this week the so-called Gang of Six Senators won the praise of representatives of over 750,000 physicians for its inclusion of a 10-year “doc fix” in Medicare payments to their proposed deficit deal. The bipartisan agreement which would slash deficits by up to $3.7 trillion over the next decade includes a 10-year, […]
State officials in Georgia have launched an investigation into suspicious contracts awarded by the Georgia Department of Public Health’s HIV unit. The internal investigation centers around $5 million in contracts issued to nonprofits that perform much of the HIV testing in Georgia. According to Georgia State Health Officer, Brenda Fitzgerald, there appears to be a […]
The Centers for Medicare & Medicaid Services (“CMS”) recently released the Medicare Fee-For-Service Recovery Audit Program (“RAC”) statistics for the third quarter of the fiscal year (“FY”) 2011. $233.4 million of overpayments was collected during that time period. In comparison, only $55.9 million of underpayments was returned during the same three month period. The latest […]
On July 8, New York Governor Andrew Cuomo nominated James Cox, a former high-level federal auditor, as New York’s new Medicaid Inspector General. The nomination is seen as an important step in increasing New York’s crackdown on Medicaid fraud. Medicaid Fraud has been a major problem for the state of New York and its $53 […]
Medicare beneficiaries are able to obtain power wheelchairs when medically necessary under Medicare Part B. From 1999 to 2003, Medicare saw a 350 percent increase in payments for power wheelchairs. The $900 million jump raised concerns regarding the appropriateness of these Medicare payments. Although the new policies implemented in subsequent years lowered these numbers, Medicare […]
In the recently released Proposed Physician Fee Schedule for calendar year (“CY”) 2012 (“Proposed Rule”), the Centers for Medicare & Medicaid Services (“CMS”) proposes changes to the Electronic Health Record (“EHR”) Incentive Program for eligible professionals (“EPs”). Under the Proposed Rule, CMS proposes the continuation of the attestation method of clinical quality measures (“CQM”) reporting […]
On July 6, 2011, Dr. Leonard Langman, a neurologist who owned and operated a Brooklyn, N.Y. medical clinic, pled guilty to one count of health care fraud for his role in a scheme to defraud Medicare, the U.S. Department of Labor, Office of Workers’ Compensation Programs (OWCP), the New York State Workers’ Compensation Board (NYS-WCB), […]
In recent years, the Centers for Medicare & Medicaid Services (“CMS”) has taken steps to address potentially undervalued and overvalued services under the Medicare Physician Fee Schedule. In the recently released Proposed Physician Fee Schedule for calendar year (“CY”) 2012, CMS specifically addresses payment codes for bone density tests. Since the payment calculation specified by […]
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