Audits, Medicare | JD Supra Law News

Health Care Services Providers to Federal Health Plan Members Subject to Federal Affirmative Action Compliance Audit

by Jonathan Cain | Mintz Levin - Health Law on 4/9/2013

On March 30, the US District Court for the District of Columbia held that three University of Pittsburgh Medical Center-affiliated hospitals were federal subcontractors to an HMO that provided a managed care health plan to...more

Hospitals: Audits And Compliance

by Michael Volkov on 4/2/2013

Hospitals are under intense scrutiny. The federal government knows that one sure way to reduce healthcare costs is to get hospitals to lower their costs. Hospitals feel the pinch given the need to generate revenue but know...more

Bipartisan Legislation to Improve Medicare Audit System Introduced in U.S. House of Representatives

by King & Spalding on 3/27/2013

On March 19, 2013, Congressmen Sam Graves (R-MO) and Adam Schiff (D-CA) reintroduced the Medicare Audit Improvement Act (MAIA or Act), which could improve some aspects of the Medicare audit system. ...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

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

Dealing with RAC Audits and Denials: How Healthcare Providers Can Manage Medicare Recovery Efforts

by Womble Carlyle Sandridge & Rice, PLLC on 2/26/2013

Executive Summary: Medicare RAC (Recovery Audit Contractor) audits are becoming increasingly aggressive, creating delays in payment for healthcare providers. Certain strategies can help mitigate delays caused by RAC audits...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

OIG Concludes in Nationwide Review of Drug That Herceptin Has Often Been Overbilled

by King & Spalding on 1/30/2013

The HHS OIG has conducted a nationwide audit of the use and reimbursement of Herceptin (also known as trastuzumab), a Medicare-covered drug used to treat metastatic breast cancer, and has concluded in three audits released in...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

Payment Matters: RACs Unleashed: 9th Circuit's Palomar Decision Gives Even More Discretion to Medicare Contractors

by Ober|Kaler on 9/24/2012

In Palomar v. Sebelius, D.C. No. 3:09-cv-00605-BEN-NLS (Sept. 11, 2012), the United States Court of Appeals for the Ninth Circuit held that a decision by a Recovery Audit Contractor (RAC) to reopen a Medicare claim for...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

A Sign of the Times: Nonpayment of Resident Accounts, Transfer/Discharge and Related Issues - Shorts on Long Term Care, May 2012

by Poyner Spruill LLP on 5/8/2012

It’s surely a sign of economic times that Poyner Spruill’s long term care lawyers have seen a marked increase in the number of clients calling us for assistance with nonpaying residents. While providers have seen...more

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