Auditors

Long-term care groups applaud a pause in Medicare audits, urge permanent changes

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Long-term care stakeholders are praising the government's decision to temporarily pause the recovery audit contractor program, which is associated with a huge backlog of Medicare claims appeals.

Overdocumentation and cloning in electronic health records are overlooked risks, investigators say

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Auditors reviewing Medicare and Medicaid claims from electronic health records are largely treating them in the same manner as paper claims, even though they pose unique risks for overbilling and fraud, according to a government report released Wednesday.

Ask the legal expert ... about using external auditors

Ask the legal expert ... about using external auditors

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What do you advise about using external auditors to check what we're doing — before wave after wave of government auditors come in?

RACs push back against audit improvement bills

RACs push back against audit improvement bills

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An advocacy group for independent Medicare auditors has sharply criticized two bills that would put new controls on Recovery Audit Contractors. The Medicare Audit Improvement Act of 2013 was introduced in the House of Representatives in March. A Senate version of the bill was introduced last month. The bill would rein in auditors and improve transparency, which have been provider concerns.

Court upholds $5.75 million verdict against former nursing home officers, board members

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A $5.75 million verdict will stand and there will be no new trial in the case against officers and board members of a former Pennsylvania nursing home, a federal judge recently ruled.

ZPICs: Dangerous and ready to take down providers

ZPICs: Dangerous and ready to take down providers

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Healthcare reform: No matter how much you may loathe it, there's no way around how certain ideas, like pay for performance, aren't going away.

Medicare auditors can request twice as many SNF medical records

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Medicare recovery audit contractors (RACs) can now request twice as many resident medical records than previously allowed, according to the Centers for Medicare & Medicaid Services.

U.S. announces new Medicaid audit program aimed at preventing fraud

U.S. announces new Medicaid audit program aimed at preventing fraud

The Centers for Medicare & Medicaid Services announced late Friday new rules aimed at stopping improper Medicaid payments to providers. Taking a page from the Medicare program, regulators have proposed using Medicaid Recovery Audit Contractors (RACs).

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