Attorney General Eric Holder and Department of Health and Human Services (HHS) Secretary Kathleen Sebelius today released a new report showing that the government’s health care fraud prevention and enforcement efforts recovered nearly $4.1 billion in taxpayer dollars in Fiscal Year (FY) 2011. This is the highest annual amount ever recovered from individuals and companies [...]
2010 Recovery Audit Program Results
FY 2010 was the first year in which the Recovery Auditors (RAC) began actively identifying and correcting improper payments under the National Recovery Audit program. All the Recovery Auditors began reviewing claims in October 2009. In the past fiscal year, the Recovery Auditors identified and corrected $92.3 million in combined overpayments and underpayments. Eighty-two percent [...]
NEXT STEPS FOR EXPANSION OF THE MEDICARE DURABLE MEDICAL EQUIPMENT, PROSTHETICS, ORTHOTICS, AND SUPPLIES COMPETITIVE BIDDING PROGRAM
The Centers for Medicare & Medicaid Services (CMS) today announced plans to expand the Medicare Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) Competitive Bidding Program. This program is an essential tool to help Medicare set appropriate payment rates for DMEPOS items and services. Except in nine areas of the country where the program is [...]
View the HEAT Provider Compliance Training Webcast
Hear from the Office of Inspector General and other government experts as they educate local health care providers, compliance officers, and their legal counsel about the realities of Medicare fraud and the importance of implementing an effective compliance program. Get the Facts. Understand the law and the consequences of violating it. Make a Plan. Cultivate a culture [...]
Effective March 25, 2011: Implementation of Provider Screening and Risk Based Categories for Provider/Supplier Enrollment
It is the continuing goal of the Centers for Medicare & Medicaid Services (CMS) to reduce fraud, waste, and abuse through all available avenues. The Affordable Care Act requires CMS to determine the level of screening to be conducted during provider and supplier enrollment based on the level of risk posed to the Medicare system. [...]
New Tools to Fight Fraud, Strengthen Medicare and Protect Taxpayer Dollars
The Affordable Care Act improves and expands consumer protections, strengthens Medicare, Medicaid and the Children’s Health Insurance Program (CHIP), and reduces health care costs. One important way it achieves these goals is by improving government-wide efforts to fight fraud, waste and abuse. The new law contains some critical new tools to improve and enhance the [...]
2011 DMEPOS FEE SCHEDULE
Revised for the January 2011. The update includes all changes identified in CR7248. Please click here 2011 DMEPOS FEE SCHEDULE to download complete listings.
The Centers for Medicare & Medicaid Services (CMS) has released a modification to the Healthcare Common Procedure Coding System (HCPCS) code set.
CMS has reinstated codes L3660 “SHOULDER ORTHOSIS, FIGURE OF EIGHT DESIGN ABDUCTION RESTRAINER, CANVAS AND WEBBING, PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT”; L3670 “SHOULDER ORTHOSIS, ACROMIO/CLAVICULAR (CANVAS AND WEBBING TYPE), PREFABRICATED, INCLUDES FITTING AND ADJUSTMENT”; and L3675 “SHOULDER ORTHOSIS, VEST TYPE ABDUCTION RESTRAINER, CANVAS WEBBING TYPE OR EQUAL, PREFABRICATED INCLUDES FITTING AND ADJUSTMENT” with the original [...]
Tougher Health Fraud Prevention Measures Proposed
The Centers for Medicare and Medicaid Services (CMS) has released a proposed rule that would implement new anti-fraud measures on physicians and medical suppliers. The proposed rule carries out provisions of the Patient Protection and Affordable Care Act. The proposal would bolster physician and supplier screening procedures, including; 1) new licensure and database checks, 2) [...]
Feds Accuse 94 of Medicare Fraud
Federal authorities have charged 94 people in what U.S. Attorney General Eric Holder called “the largest federal healthcare fraud takedown in our nation’s history.” Those being arrested in Miami, Detroit, Houston, New York and Baton Rouge, La., allegedly participated in schemes to submit more than $251 million in false Medicare claims, Holder announced at a [...]
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