Blog - Tag archives for Medicare Audit

As part of its fight against fraud, waste and abuse, CMS contracted with supplemental medical review contractors to perform and/or provide support for a variety of tasks, including performing audits.  As part of their responsibilities, these contractors perform audits to identify overpayments.  Among the many projects being worked by these contractors, is a current review Read more →

Tags : Medicare Audit

After submitting a detailed redetermination appeal on behalf of our client’s medical practice, the Firm secured a significant reduction in the overpayment demand – more than a 95% reduction.  In addition to addressing the support for the billed services found in the relevant medical records, the Firm also addressed the statistical sampling methodology used by Read more →

Tags : Medicare Audit

On August 14, 2017, CMS announced a significant change in its claims audit strategy for Medicare Administrative Contractors (MACs).  Under the new strategy — called Targeted Probe and Educate — MACs “will select claims for items/services that pose the greatest financial risk to the Medicare trust fund and/or those that have a high national error rate.”  Read more →

Tags : MACs , Medicare Audit , Medicare Claims

In a case involving a large physician practice represented by the Florida health law firm of Nicholson & Eastin, LLP, CMS reversed its decision to revoke the physician practice’s Medicare billing privileges, and immediately reinstated the billing privileges retroactive to the date of revocation. After deciding to cease operating its on-site lab operations, our Florida Read more →

Tags : Medicare Audit , Medicare Reimbursement

On May 17, 2013, HHS published a rule change that will allow state Medicaid programs to use federal funds to data mine for erroneous and false claims. The rule change is expected to generate an estimated $60 million in additional recoveries over the next decade. In order to obtain a portion of the approximately $12 Read more →

Tags : medicaid audit , Medicare Audit