Medicare Compliance & Reimbursement

Fraud&Abuse:

10 KEY MEDICARE/MEDICAID ENFORCEMENT AREAS

OIG's acting chief tells what her agency is worried about.

Despite years of stepped up enforcement, worries about health care fraud and abuse haven't gone away. And providers need to continue to take special pains to ensure their billings to Medicare and Medicaid are compliant.

Enforcement priorities, however, do change over time - and providers can take a cue on what's riling up the feds from recent congressional testimony by HHS Office of Inspector General acting-chief Dara Corrigan. In testimony prepared for the House Budget Committee, Corrigan highlighted the following areas as particular concerns when it comes to fraud, waste and abuse:

  • Medicare prescription drugs,
  • pricing of medical equipment and medical supplies,
  • Medicare contractors,
  • Medicaid prescription drug pricing anddrugrebates,
  • states' upper payment limit shenanigans, and
  • disproportionate share hospital payments.

    Other types of problems Corrigan relatedincludeimproperbillingschemes connected with:

  • cancer treatments,
  • nerve conduction tests,
  • lab tests, and
  • equipment and supplies.

     

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