February 2011 Archives

February 25, 2011

CMS Announces New Limits on RAC Record Requests

Effective February 14, 2011, CMS has limited the number of records RACs may request when reviewing Medicare claims from Physicians and other practitioners.  These requests for medical records, which are used in connection with complex claims reviews, will be limited based on the size of the group/office being audited.

If you have any questions regarding RAC, Medicare or other third party payor audits, please contact a Wachler & Associates attorney at 248-544-0888 or www.Wachler.com.

February 18, 2011

Medicare Strike Force Continues Aggressive Investigations of Health Care Providers, Makes 111 Arrests

According to a Department of Health and Human Services news release issued on Thursday, February 17, 2010, the Medicare Strike Force has indicted 111 health care providers for allegedly billing false claims to Medicare.  HHS called this the "largest ever federal health care fraud takedown."

21 defendants were arrested in Detroit for allegations of billing false claims including home health care, nerve conduction tests, psychotherapy, physical therapy and podiatry.  Arrests were also made in Florida, New York, Texas, California, Louisiana and Illinois.

HHS also announced that it is expanding Strike Force operations to two additional cities - Chicago and Dallas.  Cities already under scrutiny of the Strike Force include Detroit, Miami, Houston, Brooklyn, Tampa and Baton Rouge.

These criminal indictments are in addition to a trend of very aggressive auditing that is taking place through various contractors including RACs, ZPICs, MICs and MACs.  Providers are innocent until proven guilty and often have audits going on at the same time as criminal charges.  Aggressive defense of such audits is extremely important.  Providers who have been targeted through fraud investigations or Medicare audits should seek qualified health care counsel to vigorously defend their case.  For more information on defense of false claims allegations, Medicare fraud investigations or Medicare audit defense, please contact a Wachler & Associates attorney. 

February 11, 2011

New Issues Posted by RACs

Connolly Healthcare, the region C RAC, recently posted 77 new issues eligible for review.  Twenty-three of these new issues involve Medical Necessity reviews, several of which include reviews of acute inpatient admissions to validate the medical necessity of short stay admissions.  These new approved issues implicate a variety of MS-DRGs, which will involve reviews for the medical necessity of the services and whether the MS-DRGs, which will involve reviews for the medical necessity of the services and whether the MS-DRG at issue was billed correctly.

DCS Healthcare, the RAC for region A, posted 7 new issues for review.  The new approved issues involve MS-DRG validation.  The issue description provided by DCS Healthcare indicates that the reviews require that diagnostic and procedural information and the discharge status of the beneficiary, as coded on the claim, matches the attending physician's description and the patient's medical record.

If you are facing a RAC audit or would like more information about a RAC related issues, please contact a Wachler & Associates attorney at (248) 544-0888 or visit www.Wachler.com.

February 4, 2011

E-Prescribing Program Offers Participating Physicians Incentives

Physicians should take note of the fact that Medicare's electronic prescribing program, while offering incentives now, will soon be changed to a penalty system for those who do not adopt e-prescribing.  Early adopters are currently being rewarded with a percentage of their total Medicare payments refunded to them.  In 2011 and 2012 the amount of the refund is 1% and it drops to .5% in 2013.  Penalties for those who do not adopt e-prescribing will begin in 2012 and will be 1% of Part B earnings in 2012 for those eligible physicians who do not meet e-prescribing criteria in at least 10 Medicare office visits from January 1, 2011 to June 30, 2011.

Physicians should also be aware of the fact that incentives will not be available from both the Medicare e-prescribing and Medicare EHR incentive programs simultaneously, i.e. those physicians receiving EHR incentives will not also be eligible for e-prescribing incentives, since e-prescribing is part of the "meaningful use" criteria.

If you have questions regarding applying for and qualifying for the e-prescribing programs or meeting the meaningful use criteria for the EHR incentive programs, please contact a Wachler & Associates attorney at 248-544-0888 or www.Wachler.com