Legislators are asking industry stakeholders for input regarding potential changes to. Stark law in light of the ongoing transition towards value-based payments, according to a report by Bloomberg BNA.
It was only a matter of time before a rehab provider was nailed, in a big way, for providing unnecessary therapy to SNF patients. With RehabCare's $125 million settlement earlier this month, we saw federal prosecutors lay blame on a provider that operated within an inherently flawed payment system that incentivized ultrahigh therapy. Until that model changes, expect these settlements to continue, and for providers to take the blame for a payment model that offered virtually no structure or oversight.
Responding to "longstanding concerns" about improper payments tied to durable medical equipment (DME), the federal government issued a finale rule Tuesday aimed at reducing fraud, waste and abuse within an industry known for questionable billing practices.
The Centers for Medicare & Medicaid Services knew as far back as 2008 that certain Medicare Advantage plans were pocketing billions in overpayments, but officials still held back on auditing the plans and recouping payments tied to inflated risk scores, according to government records obtained by the Center for Public Integrity.
Last month, the Department of Health and Human Services released its Fiscal Year 2015 Agency Financial Report, and one often-criticized program stuck out like a sore thumb: Medicaid. The program's improper payment rate now sits at 9.8 percent, a significant leap from 6.7 percent in 2014, and nearly double the 5.8 percent rate in 2013. Although CMS continues to deflect blame onto the five-year-old regulation and the states, the agency is conveniently ignoring its own critical role in the transition.
The issue of including Social Security numbers of Medicare beneficiary cards has been discussed for more than four decades, including repeated warnings from the Government Accountability Office. Despite those warnings, the Centers for Medicare & Medicaid Services has failed to take even incremental steps to remove the identifying numbers, contributing to pervasive identity theft that exploits seniors and leads to millions in healthcare fraud schemes.
Preventing improper payments, which comprised $17.5 billion of Medicaid spending in 2014, represents a specific concern for the long-term health of the government-run health program, according to a report released last week by the Government Accountability Office.
Andy Slavitt, nominated by President Obama in July to replace Marilyn Tavenner as the CMS administrator, was a key player in one of the largest fraud settlements by a health insurance company.
Thousands of doctors in the Centers for Medicare & Medicaid Services' (CMS) Provider Enrollment, Chain and Ownership System (PECOS) list medical degrees from universities that no longer exist, all of which went unnoticed by CMS, and often the physicians themselves.
The transition from a reactive approach to relying on claims data to better predict and prevent fraudulent payments has led to significant progress in fighting Medicare and Medicaid fraud, former Centers for Medicare and Medicaid Services Administrator Don Berwick told the Journal for the American Medical Association.