Health agencies launch fraud prevention education campaign

Posted on June 8, 2010 | No Comments
Filed under Administration on Aging, Centers for Medicare & Medicaid Services, Department of Health and Human Services, Fraud and Abuse, Key Developments, Medicare

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The Department of Health and Human Services, Centers for Medicare and Medicaid Services, and Administration on Aging have launched a one million-dollar public-education campaign to combat fraud timed to coincide with the issuing of $250 “donut hole rebate” checks created by the health reform law. This includes radio ads in English, Spanish, Korean, and Armenian.

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A New Era of Healthcare Corporate Compliance

May 4, 2012

The Patient Protection and Affordable Care Act of 2010, as amended by the Health Care and Education Reconciliation Act of 2010 (collectively referred to as the ACA)<sup>[1]</sup> arms the federal government with significant new and enhanced tools to identify and pursue financial recovery for fraudulent, wasteful, and abusive healthcare practices. The cost of implementing other programmatic provisions of the ACA, such as coverage for the uninsured and increased fraud and abuse enforcement activities, will be paid for, in part, by monies recovered from prosecution of healthcare fraud and savings achieved from deterring fraudulent practices. Furthermore, reducing fraudulent and abusive practices is directly linked to the transformation of the health care system to a value-based system that rewards high-quality and efficient care delivery at lower cost. As the $4.1 billion recovered by the federal government in 2011 from fraud and abuse enforcement indicates, healthcare organizations, including providers (practitioners, hospitals, nursing homes), health plans, manufacturers (medical device, pharmaceutical), and suppliers (e.g., durable medical equipments companies), should expect continued aggressive enforcement in the coming years.<sup>[2]</sup> The ACA heralds a new era of compliance in healthcare that will require these organizations to monitor their operations, implement robust compliance programs, report publicly a vast array of information about their business arrangements, and face significant penalties for violations.

CMS releases final rule addressing Medicare fraud

April 24, 2012

The Centers for Medicare & Medicaid Services (CMS) published a final rule today addressing three provisions under the Affordable Care Act (ACA): 1) Medicare and Medicaid Programs; 2) Changes in Provider and Supplier Enrollment, Ordering and Referring, and Documentation Requirements; and 3) Changes in Provider Agreements. This final rule follows up on the May 5, 2010 interim final rule with comment period. It requires all providers of medical or other items or services and suppliers that qualify for a National Provider Identifier (NPI) to include their NPI on all applications to enroll in the Medicare and Medicaid programs and on all claims for payment submitted under the Medicare and Medicaid programs. In addition, it requires physicians and other professionals who are permitted to order and certify covered items and services for Medicare beneficiaries to be enrolled in Medicare. Finally, it mandates document retention and provision requirements on providers and supplier that order and certify items and services for Medicare beneficiaries. The final rule intends to prevent fraud in Medicare...

OIG report finds that contractors are unable to identify overpayments due to flawed CMS database

February 21, 2012

A study released by the Department of Health and Human Services Office of the Inspector General (OIG) presents an early assessment of the efforts of Review Medicaid Integrity Contractors (Review MIC) to conduct data analysis to identify potential overpayments and provide or recommend audit leads to the Centers for Medicare & Medicaid Services (CMS). The objectives were: (1) to determine the extent to which Review MICs completed assignments, recommended audit leads, and identified potential fraud; and (2) to describe barriers that Review MICs encountered in their program integrity activities. The OIG recommend that CMS...

NAMD releases paper with recommendations regarding Medicaid program integrity improvements

March 20, 2012

The National Association of Medicaid Directors (NAMD) issued a position paper today calling on federal policymakers to ensure that federal and state resources go to effective, high-value initiatives to strengthen the integrity of the Medicaid program. In addition to describing the landscape for Medicaid program integrity activities, the paper offers states’ perspective on the duplication and inefficiencies that currently exist. The report, "Rethinking Medicaid Program Integrity: Eliminating Duplication and Investing in Effective, High-Value Tools," makes four overarching recommendations: 1) Clarify the roles of the state and federal governments in Medicaid program integrity efforts; 2) Improve collaboration and communication between Medicare and Medicaid; 3) Invest in resources tailored to individual state Medicaid programs; and 4) Evaluate the return on investment and utility of existing program integrity initiatives.