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New Five Point Strategy Revealed
[By Staff Reporters]
According to the Report on Medicare Compliance, October 20, 2008, the Health and Human Services [HHS] Office of Inspector General [OIG] recently unveiled a five-point strategy for fighting fraud and abuse in anticipation of a new presidential administration.
Five Pillars
The five “pillars” are:
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scrutinize who is allowed to bill before enrollment.
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establish reasonable and responsive payment methodologies.
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help industry adopt practices that promote compliance.
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vigilantly monitor claims for payment, and;
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respond quickly to detected fraud.
OIG and DOJ
Among other activities, the OIG and Department of Justice [DOJ is using data mining to identify claims problems before they get out of hand.
Assessment
For example, the Office of Evaluation and Inspections [OEIs] issued a 2006 report on aberrant physical therapy billing – physicians were billing for services performed by unlicensed people in the patients’ homes – while an OIG attorney deputized by the Department of Justice [DOJ] is now prosecuting cases based on this violation in the Southern District of Mississippi.
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Filed under: Health Law & Policy, Healthcare Finance, Risk Management | Tagged: DOJ, HHS |
The Leading Business Education Network for Doctors, Financial Advisors and Health Industry Consultants 
This new bill would let Medicare delay payments when fraud and waste are suspected. Now, please define the term “suspected?”
http://www.hfma.org/hfmanews/PermaLink,guid,da410a28-afae-473c-b57d-fcdf4b05fe6b.aspx
Jeff
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Obama Supports Physician “Secret Shoppers” to Fight Fraud
In his March 10 speech, Obama said he supported legislation sponsored by Sen. Thomas Carper (D-DE) that would require all government agencies with annual budgets of more than $1 million to perform recovery audits on all of their programs.
The president also expressed interest in a proposal by Sen. Tom Coburn, MD (R-OK), to have physicians and other health professionals go undercover by posing as patients to root out fraud. Obama included it among several other GOP ideas in a proposed revision of pending congressional health reform legislation.
Dr. Coburn tried to amend the Senate health reform bill with a provision that would direct the Dept. of Health and Human Services to establish a demonstration project for the undercover investigations.
Source: Chris Silva, AMNews [3/22/10]
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NEW TECHNOLOGY TO HELP FIGHT MEDICARE FRAUD
Technology is Similar to Tools Used by Credit Card Companies, Builds on White House Campaign to Cut Waste
On the heels of the White House launch of the Campaign to Cut Waste – an administration wide initiative to crack down on waste, fraud and abuse, the Centers for Medicare & Medicaid Services (CMS) announced today that starting July 1, it will begin using innovative predictive modeling technology to fight Medicare fraud. Similar to technology used by credit card companies, predictive modeling helps identify potentially fraudulent Medicare claims on a nationwide basis, and help stop fraudulent claims before they are paid.
This initiative builds on the new anti-fraud tools and resources provided by the Affordable Care Act that are helping move CMS beyond its former “pay & chase” recovery operations to an approach that focuses on preventing fraud and abuse before payment is made.
Source: http://www.cms.gov/apps/media/press/release.asp?Counter=3983&intNumPerPage=10&checkDate=&checkKey=&srchType=1&numDays=3500&srchOpt=0&srchData=&keywordType=All&chkNewsType=1%2C+2%2C+3%2C+4%2C+5&intPage=&showAll=&pYear=&year=&desc=&cboOrder=date
But, will it work?
Ann Miller RN MHA
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Dentist admits to using paper clips in root canals
A former dentist in Massachusetts has pleaded guilty to Medicaid fraud for using paper clips instead of stainless steel posts in root canals.
http://www.msnbc.msn.com/id/46114848/ns/health-health_care/t/dentist-admits-using-paper-clips-root-canals/from/toolbar
Mary
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Medicare fraud detection system disappoints
A computer initiative to stop fraudulent Medicare billing at the point of claims submission has so far been a disappointment, reported the Associated Press.
http://www.google.com/hostednews/ap/article/ALeqM5hKmjRxUOtQXGgrsS11s1Zd9B4lJg?docId=079784078ed14200842a7dd01fe60d81
Now, is anyone surprised.
Dr. David Edward Marcinko MBA
[Publisher-in-Chief]
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Does anyone else suspect that stimulus money encouraged giddy HIT stakeholders to promise more than they could deliver, or is it just me?
Next, I think we can count on doctors being blamed by Wall Street for stubbornly refusing to change medicine for the sake of technology stocks.
What do you think?
Darrell
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CMS Auditing Program [Back to the Drawing Board?]
Over the past several months, the OIG has released several reports identifying problems with the Medicaid Integrity Program, the Comprehensive Error Rate Testing (CERT) Program, and the Medicare-Medicaid Data Match (Medi-Medi) Program, pinpointing potential ineffectiveness of the programs and significant inaccuracies in their results.
http://www.HealthCapital.com via
Ann Miller RN MHA
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