California Lawmakers Seek Update on Medicare Audit Investigation
On Thursday, two California House members wrote a letter to CMS demanding information on the outcome of an independent investigation of PRG-Schultz International, a Medicare claims auditor temporarily suspended last month, the San Luis Obispo Tribune reports (Whitney, San Luis Obispo Tribune, 11/2).
Under a contract with CMS, PRG-Schultz reviews Medicare claims submitted by hospitals to help root out improper payments. In 2005, the practice began as a pilot program in California, Florida and New York and is set to become permanent in all 50 states in coming years (California Healthline, 9/27).
The auditor has rejected more than 90% of the claims submitted by California hospitals for rehabilitation services to patients with knee and hip replacements. Under its CMS contract, PRG-Schultz receives up to a 30% commission on such claims, even if its findings subsequently are rejected on appeal.
Hospitals in California have lost millions of dollars in rehabilitation services as a result of the auditing program.
Following scrutiny from California's congressional delegation, CMS in September temporarily suspended PRG-Schultz and ordered a monthlong independent review of the program.
In their letter to CMS, Reps. Lois Capps (D-Calif.) and Devin Nunes (R-Calif.) questioned whether the auditor has been cleared to resume work.
Howard Coan, CMS spokesperson, said he could not disclose the outcome of the review.
Capps and Nunes gave CMS until Wednesday to respond to their query.
Meanwhile, Capps is preparing legislation that will place a moratorium on the auditing program before it expands nationally by 2011.
Nunes said that CMS' failure to keep California lawmakers informed on the matter has led him to sign onto Capps' bill next week (San Luis Obispo Tribune, 11/2).