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The RAConteurSince I’ve moved to the Midwest from my homeland of the East Coast, I have become much more accommodating. This morning, on my way to the office, I was in the right-hand lane of traffic next to an exit ramp. A driver was coming off the exit ramp into the slight congestion that lay beyond. She stopped in the middle of the exit ramp, and I allowed space for her to pull in front of me.
Ten seconds went by, then twenty, then thirty and the driver sat there, seemingly unable to comprehend that a space had been made available to her. Perhaps she believed it was her moment of rapture that would sweep her into the sky on a flaming, Pegasus-drawn chariot to a magical spot 10 feet from her destination, but she wasn’t moving. I briefly revisited the colorful language I tend to use when behind the wheel and left her in the dust.
With some people, it doesn’t matter how many times you wave your hand, fire warning shots or shout “LISTEN TO ME!”; no warnings are heeded and those who put forth alerts are left to view the consequences from afar. As a person who documents the progress of government audits in this space on a weekly basis, I know this feeling all too well.
While I tend to focus on recovery auditor issues on Wednesdays, a press release hit my inbox this afternoon that reminded me that this is far from the only effort to stamp out fraud and abuse in the Medicare program.
The Departments of Justice and Health & Human Services jointly announced the latest charges from the HEAT team initiative. Ninety-one individuals in 8 cities were charged for their participation in fraud schemes that resulted in roughly $295 million in false billings.
While these numbers are gaudy based on their scope, the HEAT initiative has been busy since its inception, having charged individuals with nearly $1 billion in false claims billing.
In the meantime, the recovery auditors have been ramping up operations almost exponentially. CMS set an aggressive goal of identifying nearly $1 billion in improper payments in the calendar year of 2011. Through nearly three quarters, the contractors have identified just short of $700 million, which means that over $300 million will need to be collected between now and the end of the year.
Today’s news from the HEAT team, as well as the aggressive goals yet to be achieved by the RAC program, are CMS’ attempt at firing warning shots. I am seeing that larger organizations are getting the message, but much like the car I left behind this morning, smaller providers may find themselves having a hard time dealing with the traffic of investigation if they don’t start paying attention as the warmth of Summer gives way to the Autumnal Death Cycle.
Great post Paul
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Oh, believe me, we are paying attention. We are auditing every chart, and watching the list of things they are looking for — but as a pediatric practice, we are Medicaid, and they have been doing this to us for years. But we are also swamped with EMR incentive work and ICD 10 preparations. When one is beating off alligators, it’s hard to remember the original objective was to drain the swamp.