Monday, July 2, 2012

Congress Tackles Medicare Fraud

This week, efforts to reduce Medicare fraud heightened as members of the House and Senate requested a Government Accountability Office study of the anti-fraud audits conducted by the Medicare program. The request originated from an effort to identify and eliminate fraud and improper payments. 
A number of private contractors, including Medicare Recovery Audit Contractors (RACs), Zone Program Integrity Contractors (ZPICs), and others play an important role in preventing Medicare payment fraud. The requested study will focus on the coordination and effectiveness of the anti-fraud work conducted by private contractors. The members wrote:

 “Health care providers are responsible for interacting with, and responding to, each of these contractors.  In order for this contractor oversight to at once be effective at detecting improper payments and not unnecessarily burdensome to providers, it must be undertaken subject to a coherent strategic plan, consistent standards and active coordination.

 To this end, we ask that you undertake a study that focuses on coordination among contractor efforts and CMS efforts to oversee these contractors to ensure that they are working efficiently and effectively while guaranteeing that beneficiaries are receiving care to which they are entitled.”

In related news, The Partnership for Quality Home Healthcare, a national coalition representing more than 1,500 skilled home healthcare agencies nationwide, responded to a recent solicitation by the U.S. Senate Finance Committee for recommendations for strengthening the integrity of the Medicare and Medicaid programs.  The Partnership has submitted a set of proposed reforms to prevent fraud and abuse; ensure accuracy, efficiency and value; and improve quality and outcomes:

 "Partnership members have been working together for more than a year to develop policy solutions that we firmly believe will effectively combat fraud and abuse in the Medicare and Medicaid programs."

 The Partnerships package of suggested reforms - called the "Skilled Home Healthcare Integrity and Program Savings" (SHHIPS) proposal - includes provisions that would eliminate the possibility of overpayment by preventing payment of aberrant claims before they are made and by strengthening claims review processes and conditions of participation standards.

 AHCA will continue to monitor Congressional efforts to investigate Medicare fraud. In the meantime, be sure to look at our member resources on Medicare Recovery Audits, and check out Provider Magazine’s recent cover story on ZPIC investigative tactics.

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