State, feds cooperate in fraud-busting venture.
California home care providers will receive an extra-special dose of fraud scrutiny from now on.
The arrest of the owner of a Long Beach, CA medical equipment supply business represents the "opening salvo" in a stepped-up effort to stop health care fraud in Southern California, according to U.S. Attorney Debra Yang.
Atim Okorn, owner of Pacific Care Medical Supply, has been charged with health care fraud in connection with a scheme in which he allegedly defrauded Medicare of more than $2.4 million for equipment that doctors never prescribed and seniors never received.
"I have formed a new criminal unit that is dedicated to the prosecution of health care fraud, which is unfortunately one of the big 'growth areas' of crime in our district," said Yang, who serves on the Attorney General's Advisory Committee Working Group on Health Care Fraud. The new unit includes agents from the HHS Office of Inspector General and the Federal Bureau of Investigation. Want to give your two cents on the OASIS burden? The Centers for Medicare & Medicaid Services is soliciting comments on OASIS data use and reporting as part of routine Paperwork Reduction Act requirements, according to the Jan. 25 Federal Register. Interested parties have 60 days to comment on aspects including the accuracy of the estimated burden.
More information is at
www.access.gpo.gov/su_docs/fedreg/a050125c.html.
The Scooter Store is fighting for medical equipment suppliers' right to get paid. The nation's largest supplier of power mobility goods has filed suit in federal district court in San Antonio seeking payment from Medicare for 101 power wheelchairs and scooters after the program denied its claims.
"Even though the Department's actions have produced serious financial challenges for TSS, this is about more than reimbursement to TSS," says TSS attorney Valerie Eastwood. "We are fighting for a fair and predictable process to ensure that patients continue to receive the medically necessary equipment prescribed by their doctors."
From now on, when a provider appeals an enrollment decision (such as a denial of enrollment or re-enrollment), the appeal will go to an Administrative Law Judge, CMS says in Jan. 14 Transmittal 95.
In the past, these appeals went to the carriers. The ALJs, which used to be under the Social Security Administration, are now part of the Department of Health and Human Services, potentially giving HHS more control over their decisions.
A beneficiary's signature is always required to submit a Medicare claim, CMS staff reminded providers during the latest Open Door Forum for home care providers. Confusion over signatures has arisen among providers in recent years, as Congress has made available more benefits paid on an assignment-only basis.
There's a section on the Medicare claim form where beneficiaries can indicate that they [...]
