Feds crack down on fraud by issuing new Medicaid rules, helping medical students catch fraud

The Hill Healthwatch: "The Centers for Medicare and Medicaid Services on Friday proposed new rules for the use of private contractors that work for states to audit Medicaid payments. The Recovery Audit Contractors will function similarly to the way they do in the Medicare program, where they audit payments that may have been underpaid or overpaid, and recover overpayments or correct underpayments. … Under the new law, states must establish Medicaid RAC programs by submitting state plan amendments to CMS by December 31" (Pecquet, 11/5).

In a separate posting, The Hill Healthwatch: "The Department of Health and Human Services on Friday unveiled a new tool to help medical school students learn to spot and fight Medicare fraud. The booklet, entitled 'Roadmap for New Physicians: Avoiding Medicare and Medicaid Fraud Abuse,' will go out to medical schools across the country. It explains the laws that apply to physicians so they can comply with federal law, avoid liability and spot signs of potential fraud. The release coincides with the third regional healthcare fraud prevention summit, held Friday in Brooklyn" (Pecquet, 11/5).

American Medical News: "Medicare administrators have not been using historical error rate data to identify and focus on physicians prone to mistakes when reporting claims, according to a report delivered in October by the Department of Health and Human Services Office of Inspector General. The OIG has targeted the integrity of Medicare payments as one of the top management challenges facing the Centers for Medicare & Medicaid Services. From fiscal [years] 2005 to 2008, the agency said it located 740 repeat offenders, including physicians and suppliers of medical equipment that had at least one error in each audit year and referred to them as 'error-prone providers.' … CMS reported four categories of errors: incorrect coding, medically unnecessary services, documentation errors and other errors. The OIG said that those errors, when viewed across the entire Medicare system, account for most of the $44.1 billion in improper payments that CMS reported for fiscal 2005 to 2008" (Silva, 11/8).

Detroit Free Press: "At least one in 10 Detroit seniors last year reported being scammed in the prior year, according to new research from the Wayne State University Institute of Gerontology. Nationally, one in 20 seniors reported being scammed. But even more surprising for researcher Peter Lichtenberg: It wasn't financial instability or failing minds that made seniors vulnerable — it was feelings of loneliness and being undervalued. They increased the risk of being swindled by 30 percent" (Erb, 11/8).

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This article was reprinted from kaiserhealthnews.org with permission from the Henry J. Kaiser Family Foundation. Kaiser Health News, an editorially independent news service, is a program of the Kaiser Family Foundation, a nonpartisan health care policy research organization unaffiliated with Kaiser Permanente.