Part B Insider (Multispecialty) Coding Alert

Published on Wed Sep 21, 2011 PDF

Plus: Don't forget to prep new ABN before Jan. 1.

Although you may have heard much buzz about Medicare officials suspending fraudulent providers, the story goes much deeper than that, according to a new Associated Press (AP) report that was released on Oct. 16.

"Regulators fighting an estimated $60 billion to $90 billion a year in Medicare fraud frequently suspend Medicare providers, then quickly reinstate them after appeals hearings that government employees don't even attend," the AP story noted. Although the quick reinstatements have been a godsend for legitimate suppliers who are wrongly accused or are accused of minor violations, they have been an unfortunate symptom of the clogged system when dealing with fake suppliers that bilk the Medicare system out of money.

The problems are rooted in "poor communication between one set of contractors paid to inspect Medicare providers and alert officials to suspicious activity; a separate set of contractors that handles payments; and the agency that runs Medicare," the analysis notes.

CMS reps did not explain to the AP why they didn't show up at many of the hearings, the article noted. To read the article in its entirety, visit www.postbulletin.com/news/stories/display.php?id=1472289.