California Representatives Seek To Freeze Medicare Audit Effort
On Thursday, Reps. Lois Capps (D-Calif.) and Devin Nunes (R-Calif.) plan to introduce legislation that would halt a Medicare claims auditing program for one year, the Sacramento Bee reports. The program currently is being piloted in California, Florida and New York, and it is scheduled to expand nationwide on a permanent basis.
The bill also would require Medicare administrators and the Government Accountability Office to review the program.
Capps said she expects most of the 53 members of California's delegation in the House to sign on to the bill, adding that California representatives have been asking CMS for more information about the program in California for more than two months (Whitney, Sacramento Bee, 11/8).
Under a contract with CMS, PRG-Schultz International reviews Medicare claims submitted by hospitals to help root out improper payments.
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 are rejected beyond a certain stage in the appeals process (California Healthline, 11/2).
Hospitals in California have lost tens of millions of dollars in Medicare reimbursements under the program (Sacramento Bee, 11/8).
Following scrutiny from California's congressional delegation, CMS in September temporarily suspended PRG-Schultz and ordered a monthlong independent review of the program (California Healthline, 11/2).
CMS did not respond to a request for comment, according to the Bee (Sacramento Bee, 11/8).