In 2010 alone, 552 people were charged with Medicare fraud in the U.S., got prison sentences and approximately $4 billion in assets were seized and returned to the Medicare program.
New government statistics show federal health care fraud prosecutions in the first eight months of fiscal 2011 are on pace to rise 85% over last year largely because of ramped-up enforcement efforts under the Obama administration.”
This year alone, the non-partisan Transactional Records Access Clearinghouse, show 903 prosecutions so far this year. That’s a 24% increase over the total for all of fiscal year 2010, when 731 people were prosecuted for health fraud through federal agencies across the country. Prosecutions have gone up 71% from five years ago, according to TRAC.
What does this mean to the physician, pharmacist, home healthcare agency, ambulatory service, nurses, medical assistants, healthcare administrators and billers? The government is not leaving any stones unturned in the arena of healthcare especially Medicare billing and Medicaid billing. At every turn, if Medicare and Medicaid can find a reason to audit you, they will.
Medicare’s Recovery Audit Contractors (“RAC”) are now working in full force executing audits on unsuspecting physicians. The RACs are supposed to audit all aspects of a practice but they most often focus on overpayments. Why? Because the RACs are comprised of independent contractors, hired by the government to seek out funds that are reimbursable to the government. The RACs are compensated on a contingency fee basis, based upon the principal amount collected from and/or returned to the provider or supplier. This contingency fee is significant, ranging from 9 to 12.5 percent, depending upon the RAC contract. Thus, the RACs are highly-incentivized to identify improper payments once a claim review is initiated.
Providers are urged to protect themselves.
Please direct inquires to Preeti K. Bajwa at (650) 539-8023.