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RAC Roundup: What's on the Horizon for Medicare Part C and D RACs? Medicaid RAC Implementation Is Underway
by Pamela D. Tyner, Amy Lerman, and Lesley R. Yeung The Recovery Audit Contractor (“RAC”) program is a national program aimed at identifying Medicare program overpayments and underpayments through a review of individual Medicare claims by contractors paid on a contingency fee basis....
The key figures for Medicaid eligibility are updated frequently. These figures will determine if a person qualifies for long term health care to be paid under Medicaid, as well as what assets a spouse can maintain if one spouse enters a nursing home. These figures change...
The NY Times reported in two articles here and here about the fraud by NY hospital Beth Israel Medical Center. Beth Israel Medical Center has admitted that it fraudulently increased fees for services to Medicare patients in order to receive millions of additional dollars from the federal...
The Minnesota Star-Tribune reported the decision by a federal judge in St. Paul that gave a whistle-blower permission to gather evidence in support of her allegations that the nation's largest nursing-home operator and contract physical therapy company have been submitting false Medicare and...
The OIG has conducted a review on the success of Medicaid managed care entities (MCE) in preventing excluded providers from entering their provider networks. The OIG found that all 12 selected MCEs in 10 states had safeguards to identify excluded providers, although activities varied. While 11 of...