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

Baker & Hostetler LLP
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USA
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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

ALJ appeals frequently favorable to providers; OIG calls for reforms

Baker & Hostetler LLP
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USA
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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

Annual report shows meteoric rise in RAC activity

Baker & Hostetler LLP
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USA
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February 21 2013

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

Texas Medicaid RACs announced

Baker & Hostetler LLP
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USA
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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

More hospitals face expulsion from Medicare following unannounced complaint investigations

Baker & Hostetler LLP
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USA
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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."

RACs to begin extrapolating and defending appeals

Baker & Hostetler LLP
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USA
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April 14 2011

At the recent American Health Lawyers Association's Institute on Medicare and Medicaid Payment Issues conference, the Centers for Medicare & Medicaid Services (CMS) officials provided insight into future Recovery Audit Contractor (RAC) plans for the coming year, including an effort to move away from the term RAC to Recovery Auditor and plans to update the CMS website

CMS proposes increased rewards for reporting fraud and abuse

Baker & Hostetler LLP
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USA
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May 2 2013

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

CMS clarifies physician supervision of incident-to services provided on an outpatient basis

Baker & Hostetler LLP
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USA
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June 10 2010

On May 28, 2010, CMS clarified the physician supervision requirements for diagnostic and therapeutic services provided to hospital outpatients

Medicare hearing and appeals: OMHA centralizes ALJ hearing docket

Baker & Hostetler LLP
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USA
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March 1 2012

Effective January 17, 2012, the Office of Medicare Hearing and Appeals (OMHA) implemented a centralized docketing system requiring ALJ hearing requests related to Qualified Independent Contractor (QIC) decisions nationwide to be submitted to a Centralized Docketing Office in Cleveland, rather than OMHA field offices

Little recourse in intermediary's refusal to reopen

Baker & Hostetler LLP
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USA
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December 10 2009

On November 24, 2009, the Seventh Circuit issued a decision narrowing its own prior ruling in Edgewater Hospital v. Bowen, 857 F.2d 1123 (7th Cir. 1989), in which it held that an intermediary's decision not to reopen an issue can constitute an appealable determination

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