{"id":7846,"date":"2013-07-04T17:00:49","date_gmt":"2013-07-04T21:00:49","guid":{"rendered":"http:\/\/www.poweryourpractice.com\/?p=7846"},"modified":"2013-07-04T17:00:49","modified_gmt":"2013-07-04T21:00:49","slug":"medicare-fraud-revocations-what-physicians-need-to-know","status":"publish","type":"post","link":"https:\/\/carecloud.com\/continuum\/medicare-fraud-revocations-what-physicians-need-to-know\/","title":{"rendered":"How the Surge in Medicare Fraud Revocations Affects Physicians"},"content":{"rendered":"

According to HHS, since 2011, the federal government has revoked the ability of 14,663 medical providers and suppliers to bill Medicare<\/strong>, more than doubling the number from the two years prior.\u00a0<\/span><\/p>\n

HHS Secretary Kathleen Sebelius credits President Obama\u2019s Affordable Care Act for the recent upswing in Medicare reimbursement reversals. In fact, it has resulted in the recovery of almost $15 billion in Medicare fraud money over the last three years.<\/p>\n

<\/span><\/p>\n

\u201cBy expanding our authority to suspend Medicare payments and reimbursements when fraud is suspected, the law allows us to better preserve the system and save taxpayer dollars,\u201d said Secretary Sebelius in a press release.<\/p>\n

The government plans to revamp efforts to prevent Medicare fraud by increasing the reward for reporting claim abuse from $10,000 to a potential $9.9 million<\/strong> and developing a new, easy to read the summary statement that permits recipients to see who has billed Medicare on their behalf.<\/p>\n

\u201cThe new\u00a0Medicare Summary Notice\u00a0gives seniors and people with disabilities accurate information on the services they receive in a simpler, clearer way,\u201d said CMS Administrator Marilyn Tavenner. \u201cIt\u2019s an important tool for staying informed on benefits, and for spotting potential Medicare fraud by making the claims history easier to review.\u201d<\/p>\n

Even with these new measures, not all Medicare beneficiaries will be protected. Officials are still seeking a better way to redistribute Medicare identification numbers to the 284,000 patients who have had their information breached or stolen.\u00a0<\/span><\/p>\n

What Doctors Need To Know<\/strong>
\nEven respectable physicians need to be concerned with Medicare fraud. Violations of Medicare laws can result in unpaid claims, Civil Monetary Penalties (CMPs), total exclusion from the Medicare Program, and even criminal and civil liability.<\/p>\n

The three most important federal fraud and abuse laws you should be aware of are the False Claims Act<\/a> (FCA), Anti-Kickback Statute and Physician Self-Referral Law (Stark Law).\u00a0<\/span><\/p>\n

Under these regulations, healthcare providers can be excluded from participation in all federal health programs if convicted of Medicare fraud, patient abuse, felony financial misconduct, and felony convictions for unlawful distribution of prescription drugs or controlled substances.\u00a0<\/span><\/p>\n

It\u2019s important to realize that when submitting a claim for services performed on a Medicare patient, you are filing a bill with the federal government<\/strong> and are certifying you\u2019ve rightfully earned the payment requested. Even if you merely \u201cshould have known\u201d the submitted claim was fabricated, the attempt to collect unwarranted monies constitutes a crime.\u00a0<\/span><\/p>\n

Some examples of improper claims submittals include:\u00a0<\/span><\/p>\n