Part B Insider (Multispecialty) Coding Alert

Published on Fri Mar 08, 2013 PDF

Plus: Physician ordered to pay $6.7 million and spend 50 months in federal prison.

If you think Medicare is the only government payer coming back to recoup overpayments, think again.

In its report The Department of Justice Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2012, the Department of Health and Human Services (HHS) notes that it recovered a record $835.7 million from those who attempted to defraud Medicaid in 2012. The unprecedented amount of Medicaid dollars recouped was included in the government’s total $4.2 billion that it recovered from practices that fraudulently billed federal healthcare programs.

Among the government’s recoveries from Medicaid-participating practices, HHS revealed the following case in its recent report: A North Carolina woman was sentenced to three years in prison and ordered to repay $1.1 million that she had billed to Medicaid for mental and behavioral health services that she was not licensed to perform. She also recruited other Medicaid-approved providers "to defraud by agreeing to submit false and fraudulent claims to Medicaid under their provider numbers for services which the unlicensed woman supposedly rendered," the report states.

Interestingly, the report was released right around the same time that the OIG issued a separate document stating that CMS is behind on collecting $225.6 million in Medicaid overpayments that were identified prior to 2010. The OIG urged CMS to follow up on collecting those overpayments, so if you believe you’ve collected too much from Medicaid, know that the government may come calling for a refund soon.

Resource: To read the OIG’s complete reports, visit https://oig.hhs.gov/publications/docs/hcfac/hcfacreport2012.pdf and https://oig.hhs.gov/oas/reports/region5/51100071.pdf.