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Medicare Compliance & Reimbursement

FRAUD & ABUSE:

Watch Out For Added Fraud Audits

Published on Sat Jul 07, 2007

Are PSCs laying down on the job?

Medicare contractors may be turning up the heat on your claims soon. The HHS Office of Inspector General (OIG) complained that the Program Safeguard Contractors (PSCs) aren't turning the screws hard enough on Part B providers.

Some PSCs produced 80 or fewer new investigations of Part B providers in 2005, compared to 3,707 Part B investigations from the most active PSC. And a few PSCs only referred two, three or four cases each to law enforcement, compared with 39 referrals from the most eager beaver.

Also, many PSCs didn't seem to be generating new cases by analyzing your claims data and looking for problem trends, the OIG fretted.

The OIG wants Medicare to look into the low-performing PSCs and see what more they could be doing to put the bite on fraud and abuse. If necessary, the Centers for Medicare & Medicaid Services may have to kick some PSCs to the curb.
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