Medicare Compliance & Reimbursement

OIG Recovers $3.4 Billion in First 6 Months of Fiscal Year 2011

Citing a "period of intense activity," Inspector General Daniel R. Levinson offered his Semiannual Report to Congress on June 1, unveiling the news that the OIG collected $3.4 billion between October 2010 and March 2011, with $222 million of that coming from audit recoveries alone.

The OIG brought in another $3.2 billion from 349 criminal and 197 civil actions that took place over the same time period, which left 883 individuals and entities excluded from participating in federal health care programs, a June 1 OIG news release noted. To read the entire Semiannual Report, visit the OIG's Web site at http://oig.hhs.gov/reports-and-publications/semiannual/index.asp.

Medicare officials would like to see Accountable Care Organizations help alleviate your problems with patients dually eligible for Medicare and Medicaid.

"'Dual eligibles' are among the most chronically ill and  costly individuals enrolled in both the Medicare and Medicaid programs, with many having multiple chronic conditions and/or long-term care needs," CMS says in a new fact sheet on the population.

"More than half of Medicare-Medicaid enrollees have incomes below the poverty line compared with 8 percent of other Medicare beneficiaries. Forty three percent of Medicare-Medicaid enrollees have at least one mental or cognitive impairment, while 60 percent have multiple chronic conditions." Medicare-Medicaid enrollees account for a disproportionately large share of expenditures in both programs, CMS points out. They comprise 16 percent of Medicare enrollees, yet accounted for 27 percent of Medicare spending in 2006. In Medicaid, they comprised only 15 percent of enrollees but represented 39 percent of Medicaid spending in 2007.

Among other new initiatives, establishing ACOs should help tackle this issue, CMS contends. ACOs "will work together to coordinate care for patients, and be paid for the quality of care they deliver across settings," the fact sheet says. The sheet is at www.cms.gov/apps/media/press/factsheet.asp?Counter=3954.

If you ever wondered whether whistleblowers really collected for their revelations, a new DOJ announcement proves that they absolutely do profit in some instances. An Arizona and Texas-based sleep clinic company paid the government $650,000 last week to settle allegations that they submitted false claims to Medicare, the DOJ announced on May 26.

The case was brought to the DOJ's attention as part of a whistleblower lawsuit under the False Claims Act, "which allows private citizens, known as 'relators,' to bring lawsuits on behalf of the United States and receive a portion of the proceeds of any settlement or judgment," the DOJ announcement noted. The relator in this case will receive $107,250 as her share of the recovery.

The sleep clinic allegedly filed false claims with Medicare for diagnostic sleep tests performed by technicians who lacked the licenses or certifications that Medicare requires. In addition, the settlement resolves allegations that the clinic made false claims to Medicare for medical devices resulting from the technicians' tests.

To read the complete DOJ announcement about the case, visit www.justice.gov/opa/pr/2011/May/11-civ-689.html.