Politicians pressure auditors to back down, paper claims

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Gov. Rick Scott
Gov. Rick Scott

The prospects of politician intervention with Medicare audits has sparked some debate over whether elected officials are exerting undue influence, or simply defending providers' rights against government overreaching. 

At issue is a three-year Centers for Medicare & Medicaid Services investigation into potential overbilling by 33 Florida nursing homes and the role of Gov. Rick Scott (R) in pressuring the agency to keep payments flowing.

Medicare auditors began investigating the facilities in 2011, noted a recent Wall Street Journal article, and they became concerned about potential overbilling for therapy services. The auditors implemented pre-payment reviews, which block reimbursements pending further investigation. 

At the request of the Florida Health Care Association, Scott contacted CMS Administrator Marilyn Tavenner about the situation, according to the WSJ. Scott and Tavenner previously worked together as executives at a healthcare company. After their discussion, payments were restored to the facilities.

Scott is not the only politician who has pressured Tavenner's agency to keep money flowing to providers, according to the article. The article suggested politicians want to keep large employers like nursing homes and hospitals operating in their districts. Sizeable campaign contributions from providers might act as additional incentives.

Yet some LTC industry advocates say there is nothing wrong with providers recruiting legislators to shield them.

“Nursing homes can't defend themselves and rarely win when they do,” wrote a reader at www.mcknights.com. “The whole audit system is a travesty and I am glad that politicians are doing their jobs in this case.”


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