Part B Insider (Multispecialty) Coding Alert

Published on Fri Feb 28, 2014 PDF

Plus: Be ready for ICD-10 testing this week.

If you collected $8.10 every time you spent a dollar, you’d ramp up your efforts to spend and collect more, right? That’s the logic that the Department of Justice (DOJ) is using when it continues to go after medical practices for more money after reporting its highest-ever recoveries during fiscal year 2013.

"The $1-for-$8.10 recovery record is the best return on investment that the DOJ has ever had in its history, and the agency collected $4.3 billion during 2013, also a record, according to the “Health Care Fraud and Abuse Control Program Annual Report for Fiscal Year 2013,” which the government released on Feb. 26.

These impressive recoveries for the American taxpayer are just one aspect of the comprehensive anti-fraud strategy we have implemented since the passage of the Affordable Care Act,” said HHS Secretary Kathleen Sebelius in a statement. “We’ve cracked down on tens of thousands health care providers suspected of Medicare fraud. New enrollment screening techniques are proving effective in preventing high risk providers from getting into the system, and the new computer analytics system that detects and stops fraudulent billing before money ever goes out the door is accomplishing positive results – all of which are adding to savings for the Medicare Trust Fund.”

During 2013, the DOJ filed 137 cases, charged 345 individual, got 234 guilty pleas, and 46 jury trial convictions, which led to an average of 52 months in prison for those who were sentenced in 2013.

Needless to say, it doesn’t look like the government will be slowing down its collection efforts any time soon. To read the complete document, visit http://oig.hhs.gov/publications/docs/hcfac/FY2013-hcfac.pdf.