More trouble ahead?

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03/03/2008

A few interesting news items popped up today:

The Meaning of Life the movie * If you saw the story we ran in this week's HME Newswire

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under the headline "RACs rack up refunds," you won't be surprised that CMS plans to extend its use of private contractors to examine medical records and collect overpayments beyond California, Florida and New York.

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According to Newsday: "The contractors have shown they're pretty good at their work. In just three years, they've returned more than $300 million to the federal government—and that's just from three states. That experiment is winding down. But a larger, national program will soon take its place. The rollout of 'recovery audit contractors' will be gradual. They'll monitor health care providers in 10 states beginning this spring. In October, an additional five states will join."

Providers have criticized the RAC system. Because contractors keep a percentage of the overpayments they find, they have an incentive to be "overzealous."

* The Office of Inspector General (OIG) released a report today that states providers are still having problems complying with certain Medicare standards. The OIG inspected 905 providers to see how they complied with four "easily observed rules": maintain a physical facility; be accessible during reasonable business hours; have a visible sign; and post hours of operation.

The OIG found that 115 of the 905 providers did not maintain a physical facility or were not open during unannounced site visits. Another 79 providers were open but did not meet at least one of the two additional requirements. Additionally, 124 providers met the four requirements, but "their claims had in common an atypical characteristic."

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The OIG recommends that CMS strengthen the supplier enrollment process.

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