Part B Insider (Multispecialty) Coding Alert
Carriers Tout Safeguard Hauls
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Medicare carriers are boasting once again about the financial fallout from their medical review, fraud-fighting and other payment safeguard activities.
Trailblazer Health Enterprises LLC boasts $832 million in payment safeguard savings in 2002, up from $792.1 million the previous year. Trailblazer is the Part B carrier for Texas, Maryland, Delaware, Virginia and Washington, D.C.
Prosecutors maintain that Mauskar also participated in the submission of medicare claims performed by unlicensed technicians without a physician's supervision and of claims for services that were never rendered. Mirage Medical Group ended up submitting more than $1.4 million in improper claims in 1999-2000 for which it got paid more than $500,000.
The improper billings - which also included claims for endoscopies he never performed - occurred between 1996 and 2000. Prosecutors Yesmin Saide and Faith Devine maintain that the doctor altered patient charts and medical reports to back up the inappropriate claims.
The Centers for Medicare & Medicaid Services plans to release two key regulations on the Stark physician self-referral law in coming months, according to the U.S. Department of Health and Human Services Semiannual Regulatory Agenda. Published in the May 27 Federal Register, the agenda says the much-anticipated final version of "Phase II" of the mammoth Stark physician self-referral rule is scheduled for a June release.
Also, CMS says that in July it plans to issue a proposal that could hit specialty hospitals hard. The agency says it plans to change self-referral rules to keep physician investors in certain specialty hospitals from using the "whole hospital" exception to the self-referral ban. Physician-owned specialty hospitals have been under fire lately, including proposed legislation and a General Accounting Office report.
Part B Insider (Multispecialty) Coding Alert
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Carriers Tout Safeguard Hauls
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