HCFA selects outside firms to root our health care fraud
Under the auspices of the new Medicare Integrity Program (MIP), the Health Care Financing Administration (HCFA) has selected 12 firms to augment the claims review work formerly done primarily by Medicare carriers.
HCFA is quick to say there are no incentives tied to MIP companies’ compensation. Though it’s only logical to assume that in order to have their contracts renewed or continued, MIP companies will want to build impressive track records.
The bottom line for providers could be far more aggressive investigators and investigations, some observers conclude.
HCFA got the go-ahead to hire those contractors under the Health Insurance Portability and Accountability Act (HIPAA) of 1996. Since then, many have expressed concerns that these companies will be super-charged to turn up fraud. But HCFA insists there will be no incentives tied to their compensation.
HCFA has been "fairly successful" in rooting out fraud over the last few years but now the agency wants to push the ball even further, says HCFA spokesman Craig Polaski. "These new contractors are part of that overall effort to try to tackle this problem."
Health care attorney Sandy Teplitzky says the jury is still out on how zealous the new contractors will be. "To the extent that the contractors provide clear guidance regarding the law and investigative and enforcement initiatives that are consistent and fair, I don’t think that anybody is going to have a real concern with this move," said Teplitzky, of the Baltimore law firm Ober, Kaler. "But it is critical that these firms have experience in the health care field and understand the reimbursement methodologies used by the federal health care program."
"This is the first time we have done this," Polaski adds. "These 12 contractors will become our new partners and can help us do things in a way that are different than in the past."
An outline of the Administration’s FY 2000 budget package would reportedly add collection of Medicare overpayments to the list of activities eligible for MIP dollars. The outline does not explain how HCFA would utilize the MIP money for collection activities, although Medicare contractors would presumably use the funds to further beef up recoupment efforts.
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