More Bounty Hunting Ahead

The medical community took another salvo this month.   Just   as we’ve been predicting, the Medicaid program will soon be audited by “Bounty Hunters”.  Part of the Patient Protection and Affordable Care Act recently signed into law by the President contains a directive for expanding Medicaid recovery audits in every state by the end of 2010 using contingency fee compensation.

All states are to contract with RACs to identify and recover improper payments.   This action is in addition to the Medicaid Integrity Contractors (MICs), who are not paid on a contingency fee basis.

Details are sketchy at present, but the overall picture is that Bounty Hunting is alive and well – and is here to stay.

Some physicians are considering whether to stop accepting Medicare and Medicaid patients in light of proposed cuts in payment.   This is an individual business decision each physician must make, but we advise against taking such action because of this latest development.  Truth is, Bounty Hunting is likely to spread into all major insurance companies in the near future.

The only safe course of action for any physician is careful documentation and accurate coding.   Take compliance seriously.   The best way to do that is to get an independent audit to see where you’re vulnerable.

Winston Creath is an independent healthcare consultant working in the compliance and revenue cycle management arenas on behalf of physicians and clinics.  He serves as President of National Business Solutions of GA, LLC.  He can be reached at winston@nbsoga.com for questions or comments.

Bounty Hunting Anyone?

The following quotation is from an article entitled “Obama Using ‘Bounty Hunters’ to Root Out Fraud” that appeared on the FoxNews.com website on March 10, 2010.   Although RAC is never referred to by name in this article, it is obviously what is being referred to.

Here’s the quote:

“Waste and fraud are pervasive problems for Medicare and Medicaid, the giant government health insurance programs for seniors and low-income people. Improper payments — in the wrong amounts, to the wrong person or for the wrong reason — totaled an estimated $54 billion in 2009. They range from simple errors such as duplicate billing to elaborate schemes operated by fraudsters peddling everything from wheelchairs to hospice care.

The bounty hunters in this case would be private auditors armed with sophisticated computer programs to scan Medicare and Medicaid billing data for patterns of bogus claims. The auditors would get to keep part of any funds they recover for the government. The White House said a pilot program run by Medicare in California, New York and Texas recouped $900 million for taxpayers from 2005-2008.

The presidential memorandum Obama will sign Wednesday directs Cabinet secretaries and agency heads throughout the government to intensify their use of private auditors under current legal authority. Obama also announced his support for a bipartisan bill that would expand the ways government agencies can pay for such audits using recovered funds. Among its co-sponsors is Sen. John McCain, R-Ariz., Obama’s GOP opponent in the 2008 presidential race.

The White House estimates that expanded use of private audits throughout the government could recoup at least $2 billion for taxpayers over the next three years. Much of that would come from Medicare and Medicaid, which have to scramble to keep up with the endless proliferation of new fraud schemes.

Obama his placing a heavy emphasis on battling waste and fraud in his final health care push. The repackaged bill he announced last month contained more than dozen anti-fraud ideas. A common theme linking them is the increased use of technology to spot suspicious billing patterns and keep track of service providers with a track record of problems.”

The Conclusion?

Fraud & Abuse and Medicare/Medicaid waste recovery has been brought to national attention by the current administration.  President Obama apparently believes this focus is politically advantageous, and has thrown the spotlight on it.

RACs and MICs (the soon-coming Medicaid version) aren’t going away.     Even if a provider decides this is too much and turns away Medicare and Medicaid business, other insurers (private insurance companies) are in the process of developing their own contingency fee audit plans as we speak.  Could you stay in business without them too?

As we have said before, the only course of action that makes any sense at all is to see what your exposure is and take corrective action.  A Baseline Audit is the fastest and safest way to do this.  For help, CLICK HERE.

Winston Creath is an independent executive healthcare consultant working in the compliance and revenue cycle management arenas on behalf of physicians and clinics.  He serves as President of National Business Solutions of GA, LLC.  He can be reached at winston@nbsoga.com for questions or comments.