California Lawmakers Question Review of Medicare Charges
California's Congressional lawmakers are questioning whether an auditing company contracted by CMS has been rejecting Medicare claims at rehabilitation hospitals in California in order to build profit, the Sacramento Bee reports.
The company, PRG-Shultz International, has a contract with CMS to examine Medicare reimbursements for errors. The company receives up to 30% on the billing overcharges it identifies.
The company as of Sept. 30, 2006, rejected $105 million in charges that California hospitals submitted to Medicare, according to governmental data.
The California Hospital Association in November 2006 began questioning whether the company was improperly focusing on rehabilitation hospitals. CHA in a letter to CMS called for PRG-Shultz to be suspended for improperly applying Medicare regulations and using unqualified personnel.
Sen. Dianne Feinstein (D-Calif.), whose husband holds a significant investment in the auditing company, on Thursday sent a letter to CMS that asked officials to investigate the hospital association's concerns. She said the concerns are spreading beyond rehabilitation hospitals to other types of services.
Members of the House of Representatives from California also will send a letter to CMS asking for an investigation. The letter states, "The review and collection practices of PRG-Schultz threaten access to rehabilitation services in California."
Melanie Combs, senior technical adviser for CMS, said the company's audits are "probably the first real look at these hospitals in many, many years."
PRG-Schultz declined to comment (Whitney, Sacramento Bee, 5/19).