OIG: Cutting Medicare and Medicaid fraud still a top concern

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Eliminating Medicare and Medicaid fraud should be a priority for the Department of Health and Human Services as it works to implement healthcare reform programs, according to a new report.

HHS has made great strides in screening healthcare providers, such as nursing homes, as part of heightened fraud and abuse prevention efforts the Office of the Inspector General report states. But the department should adopt “a more flexible screening approach, tailoring screening measures to fraud risks, and classifying re-enrolling DME [durable medical equipment] and home health providers as ‘high risk,'” the report says.

Additionally, HHS should continue to recoup improper Medicare and Medicaid payments. HHS  “should also continue to monitor its payment systems to identify additional edits and prepayment reviews that could identify suspicious claims and prevent improper payments,” according to the report. In fiscal year 2010, HHS reported $70 billion in improper payments from Medicare fee-for-service, Medicare Advantage, and Medicaid, according to the OIG. Click here to read the report.

In other fraud news, the Centers for Medicare & Medicaid Services announced that three demonstration projects, including the delayed Recovery Audit Prepayment Review Demonstration, are expected to start running on June 1. Click here to read the Federal Register posting, or click here to read a McKnight's guest column on "How to make your nursing facility RAC-ready."

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