Articles Posted in Medicare overpayment reporting

MedicareFull coverage of Medicare Part A benefits is said to be at risk within seven years as funding begins to run out. This could potentially lead to long-term effects that will be devastating to a large number of nursing homes and those who operate them, as well as the healthcare system as a whole.

Generally, Medicare Part A is responsible for covering inpatient care in a hospital, skilled nursing facility care, hospice care, and through home health care programs. Medicare is based on the laws set by the state and federal government, and it is up to national and local decision-makers to set the coverage standards.

The Hospital Insurance (HI) Trust Fund directly supports Medicare Part A benefits, which include skilled nursing services and facilities. This fund will only have the means to help provide these benefits up until 2026, according to the findings of the Medicare Board of Trustees. These are the same findings recorded last year and display a serious potential for a decline in spending on skilled nurses.

Federal prosecutors in Florida are pursuing an unusual criminal fraud case  taking aim at billing practices of Medicare Advantage plans, which are popular with seniors because out-of-pocket costs are lower and they provide more benefits than traditional Medicare.The case centers on a South Florida doctor affiliated with Humana Inc., one of the industry’s biggest players.

A federal grand jury in West Palm Beach, Fla., indicted the doctor, Isaac Kojo Anakwah Thompson, on eight counts of health care fraud on Feb. 4. He’s accused of cheating Medicare out of about $2.1 million by claiming his Humana-enrolled patients were sicker than they actually were. Thompson, 55, was arrested and is free on a $1 million bond. Through his lawyer, he declined comment.

The indictment does not accuse Humana of wrongdoing and the company has repaid the Government.

Improper Medicare payments and fraud cost the taxpayers in excess of $50 billion last year alone, according to a report by Health and Human Services. Medicare spent over $554 billion last year.

The Centers for Medicare and Medicaid Services (CMS) has instituted new programs to prevent fraud and has started to screen 1.5 million Medicare suppliers. So far over 160,000 providers have had their billing privileges deactivated .

The latest budget requests $428 million for Medicare fraud prevention programs that could yield $13.5 billion in savings.

Health care providers are required to report and refund any overpayment of Medicare/Medicaid funds within 60 days after the overpayment was identified. Failure to do so is a direct violation of the False Claims Act and all of its fines, penalties on top of recovered moneys. A lack of vigilance in this area carries heavy risk.