Medicare audits/fraud/pre-authorization in our profession- comments
Randy McFarland
Description
Collection
Title:
Medicare audits/fraud/pre-authorization in our profession- comments
Creator:
Randy McFarland
Date:
5/23/2013
Text:
RAC audits-
Is the claw back of Medicare funds an attempt to get at those who are
fraudently billing or is it to get funds back from those without the time or
resources to put up a fight? It IS a conflict of interest when the auditors
are paid a commission when they can arbitrarily take money back for services
provided in good faith. What is the auditors motivation to be impartial?
What happens to them if their decision is overturned by an ALJ? What
recourse is there when someone is unfairly targeted?
Fraud-
Let's hear ideas on how Medicare could more efficiently focus in on
fraudulent billers instead of making things more difficult for everyone who
chooses to care for Medicare patients. Intentional fraud should be
prosecuted! One idea would be to have Medicare make public the name and
addresses of places that submit O&P invoices to Medicare. The legitimate
practitioners generally know about each other, but I wonder who else is
invoicing O&P procedure codes in our area that we've never heard of?
Pre-authorization-
This fiasco makes me wonder if the Medicare O&P services vetting process
should take place BEFORE services are provided rather than after the fact.
Randy McFarland,CPO
Is the claw back of Medicare funds an attempt to get at those who are
fraudently billing or is it to get funds back from those without the time or
resources to put up a fight? It IS a conflict of interest when the auditors
are paid a commission when they can arbitrarily take money back for services
provided in good faith. What is the auditors motivation to be impartial?
What happens to them if their decision is overturned by an ALJ? What
recourse is there when someone is unfairly targeted?
Fraud-
Let's hear ideas on how Medicare could more efficiently focus in on
fraudulent billers instead of making things more difficult for everyone who
chooses to care for Medicare patients. Intentional fraud should be
prosecuted! One idea would be to have Medicare make public the name and
addresses of places that submit O&P invoices to Medicare. The legitimate
practitioners generally know about each other, but I wonder who else is
invoicing O&P procedure codes in our area that we've never heard of?
Pre-authorization-
This fiasco makes me wonder if the Medicare O&P services vetting process
should take place BEFORE services are provided rather than after the fact.
Randy McFarland,CPO
Citation
Randy McFarland, “Medicare audits/fraud/pre-authorization in our profession- comments,” Digital Resource Foundation for Orthotics and Prosthetics, accessed November 5, 2024, https://library.drfop.org/items/show/235133.
