Are the Feds Looking for Fraud in Detroit?


The Centers for Medicare & Medicaid Services (“CMS”) is taking a proactive step toward preventing fraudulent repayment claims before they occur by blocking several home health agencies and ground ambulance suppliers from enrolling in and receiving reimbursement from government programs.

Although CMS is proactively investigating and blocking agencies across the country, CMS is also including local Detroit agencies as well.  “The affected entities are located in Detroit, as well as Chicago; Fort Lauderdale, Fla.; Miami; Dallas; Houston; and the Greater Philadelphia area.”

“The freezes are allowed under a provision in the Patient Protection and Affordable Care Act that aims to move the CMS beyond a ‘pay and chase’ fraud model to one that’s focused on prevention.”  “The CMS chose to focus on these areas following consultation with HHS’ Office of Inspector General and the Justice Department, which found a disproportionate number of providers and suppliers relative to beneficiaries along with extremely high utilization in these areas.”  “Barry Scott Cargill, executive director of the Michigan Association for Home Care, said he believes the problem of Medicare fraud in Wayne County has been compounded by increasing enforcement around the country, which has caused some home health agencies perpetuating the fraud in other cities with the moratorium to move here.  One reason Wayne County seems to attract those individuals is because Michigan doesn’t require licensure of home health agencies like other states do.  Medicare fraud is a large problem in the country, and these are tools the state and federal government can use to combat it.” Crain’s Detroit Article, February 3, 2014.

Medicare is looking at your billings as they compare to other healthcare providers with your specialty.  If your billings are significantly higher, you will be a target for the feds.

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