Adds Another $250 Million to Combat Medicare Fraud and Errors The new health reform legislation signed by President Obama on March 23 (H.R.3590), plus the reconciliation “fixes” enacted on March 25 (H.R. 4872) provide $250 Million of additional funding for Medicare audits and enforcement, create new federal enforcement tools, create a new Stark self-disclosure process, […]

Council Denies CMS Appeal The Medicare Appeals Council (Council) disagreed with the Centers for Medicare and Medicaid Services (CMS) when asked by CMS to review and overturn a September 2009 decision by an Administrative Law Judge (ALJ). The case concerns an ALJ decision that agreed with a Demonstration Project RAC to deny Medicare coverage for […]

RACs identify fraud cases and improper payments The Centers for Medicare & Medicaid Services (CMS) conducted a demonstration project from 2005 to 2008 to detect and correct past improper payments in the Medicare fee-for-service program, and to provide information to CMS and the Medicare claims processing contractors that could help protect Medicare trust funds by […]

Realized Nearly $4 Billion in Settlements, Fines, Penalties & Restitution In fiscal year (FY) 2009, OIG’s enforcement efforts resulted in over 670 criminal actions, of which 515 involved heath care fraud; over 362 civil actions (355 involved health care fraud); and realized nearly $4 billion in settlements and court-ordered fines, penalties, and restitution, approximately 75 […]