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CMS proposes increased rewards for reporting fraud and abuse

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • May 2 2013

The Centers for Medicare and Medicaid Services (CMS) recently published a proposed rule modifying certain provisions in their Incentive Reward

Annual report shows meteoric rise in RAC activity

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • February 21 2013

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

American Taxpayer Relief Act amends overpayment recovery time limits

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • January 10 2013

The ATRA significantly alters provider rights related to overpayment recoupment, refunds, audits and claims appeals. A provision entitled "Removing

ALJ appeals frequently favorable to providers; OIG calls for reforms

  • Baker & Hostetler LLP
  • -
  • 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

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

  • Baker & Hostetler LLP
  • -
  • 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

House bill proposed to reform Medicare RAC, MAC and ZPIC audits

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • October 25 2012

The Medicare Audit Improvement Act of 2012, a House bill introduced on October 16, 2012 (Bill), proposes to improve the operations of recovery auditors (RACs), as well as increase transparency and accuracy of audits conducted by other Medicare contractors, including Medicare administrative contractors (MACs), fiscal intermediaries and zone program integrity contractors (ZPICs

Texas Medicaid RACs announced

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • September 27 2012

The Texas Health and Human Services Commission (HHSC) recently announced a tentative contract award for the Texas Medicaid Recovery Audit Contractor (RAC) contract to both CGI Federal, Inc. and Health Management Systems, Inc. (HMS

Medicare fraud strike force fans out across seven cities; 107 licensed professionals charged

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • May 10 2012

On May 2, the U.S. Department of Justice (DOJ) and Department of Health and Human Services (HHS) announced a nationwide takedown by Medicare Fraud Strike Force operations resulting in charges against 107 individuals, including doctors, nurses and other licensed medical professionals, for their alleged participation in Medicare fraud schemes

Texas Medicaid RAC and intent to delay implementation announced

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • April 26 2012

The Texas Health and Human Services Commission (HHSC) has announced a "tentative contract award" for the Recovery Audit Contractor (RAC) Program for Texas Medicaid to CGI, Federal, Inc

More hospitals face expulsion from Medicare following unannounced complaint investigations

  • Baker & Hostetler LLP
  • -
  • USA
  • -
  • April 12 2012

A Pennsylvania hospital faces termination from the Medicare program following an unannounced complaint investigation by state health authorities in late March that found "there was a significant threat to the well-being of the patients at the facility."