CMS proposes increased rewards for reporting fraud and abuse *

USA - May 2 2013
The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule modifying certain provisions in their Incentive Reward…

Co-authors: B. Scott McBride.

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Annual report shows meteoric rise in RAC activity *

USA - February 21 2013
On February 5, 2013, CMS issued its mandatory Recovery Audit Contractor (RAC or Recovery Auditor) program annual report, detailing overpayments…

Co-authors: B. Scott McBride.

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American Taxpayer Relief Act amends overpayment recovery time limits *

USA - January 10 2013
The ATRA significantly alters provider rights related to overpayment recoupment, refunds, audits and claims appeals. A provision entitled "Removing…

Co-authors: B. Scott McBride.

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ALJ appeals frequently favorable to providers; OIG calls for reforms *

USA - December 6 2012
The OIG recently published a report reviewing the implementation of 2005 regulations regarding the administrative law judge level of appeals, the third level of the Medicare appeals system.

Co-authors: B. Scott McBride.

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AHA sues HHS for refusal to pay for denied inpatient claims as outpatient services *

USA - November 8 2012
On November 1, 2012, the American Hospital Association (AHA) and four healthcare providers brought suit against HHS for maintaining a policy of refusing to pay for medically necessary care provided to patients.

Co-authors: B. Scott McBride.

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