Support Grows for Bill Seeking To Freeze Medicare Audit Program
Hospital officials in Florida and New York are backing legislation by Reps. Lois Capps (D-Calif.) and Devin Nunes (R-Calif.) 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 permanently to 20 more states in March 2008 (Whitney, Sacramento Bee, 11/26).
The bill would require Medicare administrators and the Government Accountability Office to review the program.
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.
Hospitals in California have lost tens of millions of dollars in Medicare reimbursements under the program (California Healthline, 11/12).
Hospital officials in New York and Florida that support the legislation also have experienced problems with the program in their respective states. However, officials in both states contend that California has experienced more severe incidents.
Meanwhile, the American Hospital Association is working to pass the bill. Among the organization's concerns with the program is the commission that the auditor receives for claims.
Despite growing support for the measure, it is unlikely that it will pass as stand-alone legislation before the program expands in March, according to the Bee.
However, the bill could be merged into a measure involving Medicare physician fees that Congress is under pressure to enact before Jan. 1, 2008 (Sacramento Bee, 11/26).