Recovery of Medicare and Medicaid overpayments in bankruptcy.

Comprehensive Application of Predictive Modeling to Reduce Overpayments in Medicare and Medicaid

“UPCODING” PROBLEM EXACERBATES OVERPAYMENTS TO MEDICARE ADVANTAGE PLANS Administration Action and House Health Reform Bill Seek to Address Problem

Private plans were brought into Medicare on the theory that they could deliver Medicare services at lower cost. However, the Medicare Payment Advisory Commission (MedPAC) — Congress’s expert advisory body on Medicare payment policy — has found that Medicare pays private plans 14 percent more than it costs to treat the same beneficiaries in the traditional Medicare program. These overpayments th...

What every CEO should know about Medicare's recovery audit contractor program.

Under the Affordable Care Act, President Obama expressed his support for the use of “high-tech bounty hunters” to help fight healthcare fraud in the Medicare and Medicaid programs (US Government 2010). President Obama was referring to the recovery audit contractors (RACs) employed by Medicare, tasked to identify and correct improper Medicare payments. Contractors are highly incentivized to iden...

Minimum Value of Eligible Employer-Sponsored Plans and Other Rules Regarding the Health Insurance Premium Tax Credit. Final regulations.

This document contains final regulations on the health insurance premium tax credit enacted by the Patient Protection and Affordable Care Act and the Health Care and Education Reconciliation Act of 2010, as amended by the Medicare and Medicaid Extenders Act of 2010, the Comprehensive 1099 Taxpayer Protection and Repayment of Exchange Subsidy Overpayments Act of 2011, and the Department of Defen...

US Inspector General recoups millions in audits, fraud, and abuse investigations.

Fraud and abuse investigations by the office of the Inspector General resulted in payments totaling $407.7 million. Audits by the same agency identified $251.5 million in items such as overpayments, according to the agency’s mid-year fiscal year 1999 report. As a result of its findings, the Inspector General recommended exclusion of 2976 individuals or entities from government programs such as ...