Healthcare reform is currently at the forefront of both the Federal and State governments’ agendas. In an effort to curtail government spending on federal healthcare programs, the government has stepped up enforcement by increasing provider audits in order to collect payments it feels were erroneously paid to healthcare providers. Healthcare providers and facilities, especially those located in Los Angeles, have reported a surge in audit notices from Recovery Audit Contractors (RAC) working for the Center for Medicare and Medicaid Services (CMS).
Adverse healthcare audits of providers and facilities can result in a civil recoupment action to collect payments alleged to be erroneous or a criminal fraud prosecution.
Common recoupment and fraud allegations include:
Up-coding medical services rendered
Fraudulent billing for medical services
Improper billing of medical services rendered
Double billing/overbilling for medications or medical equipment
Providing unnecessary medical treatment
False claims submitted