July 15th, 2013
Recently Medicare issued a press release about their updated Medicare Summary Notice. The Obama Administration has made the elimination of fraud, waste, and abuse a top priority and the number of providers thrown out of Medicare programs has more than doubled in the last few years. The newly designed Medicare Summary Notice gives seniors and other Medicare beneficiaries clear and accurate information about the services they received and the payments made to providers.
Medicare hopes that seniors will be able to spot claims for services never received and other potential problems with claims filed by providers on their behalf. As an incentive to help catch unscrupulous providers, CMS has proposed an increase (to just under $10 million) in the potential rewards to whistleblowers whose tips lead to successful funds recovery. Under the Affordable Care Act the Obama Administration has made record recoveries from healthcare fraud in 2011 and 2012 and thousands of providers have been excluded from participation in Medicare for non-compliance with CMS rules.
These new Medicare Summary Notices may also mean that seniors are more likely to accuse providers of fraud when none has actually transpired. For example, beneficiaries who are encouraged to report fraud and have memory issues may not recognize a charge on a Medicare Summary Notice even though it actually occurred. Be sure to communicate clearly with Medicare patients, document everything, and fill out the Advanced Beneficiary Notice (ABN) form according to Medicare guidelines.
For training on this and other compliance issues, contact us.
See the complete article (with maps of which states have had the most providers excluded) at cms.gov.