Medicare Compliance & Reimbursement
CMS' Analytics System Caught $820 Million in Fraud
CMS uses many approaches to catching fraud, and its high-tech analytics system is one of the most lucrative tools for the agency. On July 14, CMS announced that its Fraud Prevention System identified or prevented $820 million in inappropriate payments over a three-year period, with $454 million of that amount in just 2014 alone.
The system uses analytics software to identify questionable billing patterns among Medicare claim submissions. “In one case, one of the system’s predictive models identified a questionable billing pattern at a provider for podiatry services that resulted in Medicare revoking the provider’s payments and referring the findings to law enforcement,” CMS said in the news release announcing the savings. CMS hopes to expand the Fraud Prevention system algorithms to lower-levels of compliance among healthcare providers who need education on claims submissions.
“We are proving that in a modern health care system you can both fight fraud and avoid creating hassles for the vast majority of physicians who simply want to get paid for services rendered. The key is data,” said CMS Acting Administrator Andy Slavitt in a statement. “Very few investments have a 10:1 return on taxpayer money.”
Medicare Compliance & Reimbursement
- Enforcement News:
How The Latest Massive Medicare Fraud Takedown Is Changing Enforcement
Beware: Medicare Part D now under scrutiny for upcoming fraud actions. The biggest Medicare fraud [...] - What the OIG is Scrutinizing Regarding Medicare Part D Billing
Watch prescriptions for ‘commonly abused opioids.’ Since 2006, Medicare spending for commonly abused opioids has [...] - Part B Payment:
New Codes Without Pay Attached, 0.5 Percent Pay Increase Come January
Good news: You won’t face payment insecurity issues in 2016. The Centers for Medicare & [...] - CMS Dips Toe Into MACRA Shift
As most practices know, the Centers for Medicare & Medicaid Services (CMS) is planning to [...] - ICD-10 Update:
Physician Payments Linked to Procedure, Not Diagnosis
Hint: ICD-10-CM defines diagnosis coding. Your Medicare payments could be at stake unless you’re aware [...] - Reader Question:
Medicare Shares ICD-10 Help With Road to 10
Question: Our entire office is pitching in to prepare for the switch over to ICD-10 diagnosis [...] - Reader Question:
Is it Critical for the ED Physician To Document a Full History for Code 99291?
Question: Does the emergency department (ED) physician need to complete all the HPI, ROS, history, and [...] - Industry Notes:
Does Your Employee Confidentiality Policy Violate The NLRA?
Even if your employee’s conduct violates HIPAA, that doesn’t mean terminating that employee won’t violate [...] - Industry Notes:
CMS' Analytics System Caught $820 Million in Fraud
CMS uses many approaches to catching fraud, and its high-tech analytics system is one of [...]
