Medicare Compliance & Reimbursement

Medicare contractors are boasting once again about the financial fallout from their medical review, fraud-fighting and other payment safeguard activities. Regional home health intermediary Palmetto GBA, for example, is touting the $872 million it withheld or recouped from providers in 2002 as costs savings to the government. Palmetto's benefit integrity unit helped "identify and pursue highly abusive and/or fraudulently billed services" to the tune of $98.8 million. Provider audits recovered $101.8 million and secondary payer efforts resulted in $400 million, the RHHI says. Meanwhile sister company Trailblazer Health Enterprises LLC boasts $832 million in payment safeguard savings in 2002, up from $792.1 million the previous year. Trailblazer is the fiscal intermediary for Texas, New Mexico and Colorado and the Part B carrier for Texas, Maryland, Delaware, Virginia and Washington, DC, among other Medicare claims processing duties. Lesson Learned: With Medicare contractors' powerful incentives to boast a tough track record on medical review and fraud fighting, compliance and solid documentation is as crucial as ever for health care providers' bottom lines.