Medicare Sting In Force

In coming weeks, private audit companies will begin scouring mountains of medical records. Their mission: Determine if health care providers erred when billing Medicare and require them to return any overpayments to the federal government. The auditors will keep a tidy percentage for their services. The contractors have shown they're pretty good at their work. In just three years, they've returned more than $300 million to the federal government - and that's just from three states. That experiment is winding down. But a larger, national program will soon take its place. The rollout of "recovery audit contractors" will be gradual. They'll monitor health care providers in 19 states beginning this spring. In October, an additional five states will join.
Hospitals and physicians with a compliance plan in place will have a better chance of avoiding this sting operation. The outsourceing of this sting operation to private audit firms is disturbing. The fact that these auditors will "keep a healthy percentage" of the overpayments is incentive to dig deep for audits. Paying these audit firms based upon a percentage of the overpayments is interesting. The same government prohibits providers from paying biling services and other vendors on a percentage of money paid to the provider. This could open the door for legal action by the providers. Please contact me if you are a target of this sting immediately! I can help with recommending health care attorneys and in reviewing the results of any errors found by these contracted auditors.