Audits, CMS | JD Supra Law News

Self-Audit Results Found Sufficient to Sustain False Claims Act Complaint

by Robert Mazer | Ober|Kaler on 5/2/2013

District Court Finds That Medical Group’s Failure to Further Investigate Audit Results May Violate Requirement to Return Overpayments - Background - Internal audits of third-party payment claims – frequently...more

CMS Focuses on Fraud Associated with Increased Use of Electronic Health Records

by Tom Crane | Mintz Levin - Health Law on 3/22/2013

Acting CMS Administrator, Marilyn Tavenner, recently reaffirmed the agency’s concern that the increased use of electronic health records (“EHRs”) has contributed to increases in fraudulent billing practices by providers. At a...more

Hospitals Provided Temporary Relief In Medicare Rebilling Policy

by Madeline Engel, Renee M. Howard, David B. Robbins | Perkins Coie on 3/21/2013

The Centers for Medicare & Medicaid Services (CMS) released a ruling and an interim rule that, effective immediately, will allow hospitals to rebill certain inpatient hospital services as outpatient services for one year...more

OIG Reports that Millions of Medicaid Overpayments Remain Uncollected

by King & Spalding on 2/28/2013

On February 19, 2013, the OIG published a report detailing the collection status of Medicaid overpayments. The Secretary of HHS requires CMS to collect overpayments, defined as “the amount paid by a Medicaid agency to a...more

Annual Report Shows Meteoric Rise in RAC Activity

by Ameena Ashfaq, B. Scott McBride | BakerHostetler on 2/27/2013

On February 5, 2013, CMS issued its mandatory Recovery Audit Contractor (RAC or Recovery Auditor) program annual report, detailing overpayments, underpayments, RAC performance and savings to the Medicare program. According to...more

CMS Publishes Annual Update On Recovery Audit Activity, Says Program Returned Nearly $490 Million to Medicare Trust Fund in 2011

by King & Spalding on 2/13/2013

On February 5, 2013, CMS sent Congress a report summarizing developments related to its Medicare recovery audit program for fiscal year (FY) 2011. According to the report (titled Recovery Auditing in the Medicare and...more

Audits, Audits And More Audits: Life In The Healthcare Industry

by Michael Volkov on 1/13/2013

Healthcare suppliers and service providers live in a regulated world. They are constantly under audit scrutiny. Sometimes federal agencies (i.e private contractors) conduct the audits; other times state agencies conduct the...more

ZPICs and Skilled Nursing Facilities: Medicare’s Wild Wild West

by Fuerst Ittleman David & Joseph, PL on 1/11/2013

Fraud and abuse in the Medicare system undoubtedly increases healthcare costs for healthcare providers and healthcare beneficiaries. As such, healthcare providers, as a whole, can appreciate the efforts of the Department of...more

Meaningful Use Mash-Up: Update on Deadlines, Changes for Stage 2, and the Start of MU Audits

by Davis Wright Tremaine LLP on 10/2/2012

The march towards electronic health records (“EHRs”) and health information exchange continues. It is worth noting a number of recent changes to the Medicare and Medicaid Meaningful Use programs governing incentives for...more

Medicare and Medicaid Audit Defense & Appeals: From RACs to ZPICs (Presentation)

by Jackson Walker on 9/30/2012

In This Presentation: Acronyms; MEDICARE V. MEDICAID AUDITS; RECOVERY AUDIT CONTRACTOR PROGRAM; Background of the RAC Program; Demonstration Program; Permanent Program; Who are the Medicare Recovery Audit...more

Medicare Audit Challenges to Paying Nursing and Allied Health Program Pass-Through Costs

by McDermott Will & Emery on 9/21/2012

The Medicare program shares in the costs for approved nursing and allied health education programs operated by hospitals, a matter which has become a recent focus in Medicare audits of hospitals operating such programs....more

Shorts on Long Term Care - May 2012

by Poyner Spruill LLP on 5/9/2012

In this issue: - A Sign of the Times: Nonpayment of Resident Accounts, Transfer/Discharge and Related Issues - Responding to an Audit? Be Prepared! - Ken’s Quote of the Month An excerpt from...more

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Audits › Centers for Medicare & Medicaid Services