PPACA Medicare Contracting Reforms Enable Random Prepayment Review, But Implementation Faces Obstacles By W. Bruce Shirk

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Random prepayment review of health care claims is a critical element of any truly effective effort to combat the submission and payment of fraudulent health care claims.

This article addresses the recent history of such review in the context of the Medicare program, including Congress’s prohibition of the practice in 2003, Congress’s repeal of the prohibition in 2010, and the significance of these and related events to the effort to combat the submission and payment of fraudulent Medicare claims.

Please see full article below for more information.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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