Recovering Funds, Preventing Fraudulent Activity, and Exercising Compliance
The federal government has revved up its battle against Medicare fraud, recovering more than $14.9 billion during the last three years. Now a new proposed rule from the U.S. Health and Human Services (HHS) Department would increase rewards to those who help the government recover funds.
The proposed new incentive program would boost rewards up to $9.9 million— if HHS’ Centers for Medicare and Medicaid Services (CMS) recovers $66 million or more as the result of the tip, CMS officials announce.
The current cap is $1,000, which rewards tipsters on the first $10,000 recovered. The proposed rule would also help CMS detect new fraud schemes. Since CMS began its reward program in 1998, it has recovered around $3.5 million and paid $16,000 in rewards, CMS officials report. Public comment was being accepted and closed on June 28.
As medical practitioners and keepers of patient data, physicians hold a position of trust and can make a real difference in the fight against Medicare fraud. One of the most important things doctors can do is become aware of their legal responsibilities and about how others are abusing the system.
The False Claims Act, Anti-Kickback Statute,Physician Self-Referral Law (Stark Law), Social Security Act, and the U.S. Criminal Code address Medicare fraud and abuse. To report violations, providers can call 1-800-HHS-TIPS (1-800-447-8477) or email HHSTips@oig.hhs.gov.
Physicians should be leery when offered free rent or below-market rent or other enticements. Patient care decisions should not be affected by these enticements. In such situations, legal counsel is advised, CMS officials say.
Physicians also should have checks in place to ensure the government is not billed for free medical samples provided, CMS officials suggest.
By adopting a compliance program, doctors can help avoid fraudulent activities. According to CMS officials, the program should include internal monitoring, designating a compliance officer, maintaining open communication with employees, and enforcing disciplinary standards. A compliance program is mandated for those treating Medicare beneficiaries under the Affordable Care Act.
CMS also offers a self-disclosure plan to those who have recognized a problem with Medicare billing practices, including severing suspicious relationships, ceasing the bills in question, seeking legal advice, and considering disclosure of potential violations.
More information is available at http://www.cms.gov/Outreach-and-Education/Medicare-Learning-Network-MLN/MLNProducts/Downloads/Avoiding_Medicare_FandA_Physicians_FactSheet_905645.pdf. This detailed document provides a roadmap for physicians on preventing Medicare fraud and abuse as well as delving into compliance strategies to ensure accuracy of claims.
Doctors can protect patient’s data and identities by not gathering and storing unnecessary data. Those who have access to the data should be few.
President Barack Obama has stepped up the battle against fraud and abuse. In October, a Medicare Strike Force led to charges against 91 people for their alleged involvement in $432 million in false bills, according to CMS.
Under the Affordable Care Act, the net will close on providers who attempt to move to another state by requiring all states to terminate anyone whose billing privileges have been revoked by Medicare, CMS officials say. It includes those dropped “for cause” by Medicaid in other states.
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story by CHERYL ROGERS