Tag Archives: audit

AOPA backed audit lawsuit dismissed by District Court

Posted on August 6, 2014 by

The United States District Court of the District of Columbia recently dismissed a case brought by the American Orthotic and Prosthetic Association (AOPA) against Former Secretary of the Department of Health and Human Services Kathleen Sebellius. The suit focused on the authority of … Continue reading →

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CMS Informs Congress of intention to re-start portions of RAC program

Posted on August 5, 2014 by

From HealthDataManagement.com : The Centers for Medicare and Medicaid Services is restarting the controversial Recovery Audit Contractor Program—in a limited fashion—in August. CMS sent a communication on August 4 to congressional health staff members from Lauren Aronson, Director of the … Continue reading →

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ALJ Forum Light on Relief, Stakeholders Voice Frustrations

Posted on February 12, 2014 by

The Office of Medicare Hearings and Appeals held a forum today in Washington DC on the recently disclosed 460k Administrative Law Judge (ALJ) appealed claims backlog. Chief ALJ Nancy Griswold headlined a day long event which featured updates from OMHA … Continue reading →

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How to stop CMS from taking your $$

Posted on June 24, 2013 by

I wanted to pass along this great post from Linda Collins and the Ossur Regulatory blog. Linda describes how an independent O&P can stop CMS from withholding/requesting overpayments until much later in the appeals process by being organized and replying … Continue reading →

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CERT Prepayment Review on High Cost Claims Shows 89% Denial Rate

Posted on January 3, 2013 by

NGS in Jurisdiction B recently completed an analysis of prepayment review claims focused on medical necessity in the third quarter of 2012. The claims selected were based on a selection of high dollar claims and targeted services from multiple suppliers. The review included claims for orthotics … Continue reading →

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OIG: ALJ’s Overturn 56% of Provider Generated Appeals to QIC Audits

Posted on November 30, 2012 by

The HHS Office of Inspector General earlier this month released a report which studied the shockingly high overturn rate of provider generated appeals to private contract auditors employed by CMS to the Administrative Law Judge level.  The OIG found that 56% … Continue reading →

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HHS Releases Medicaid RAC Final Rule

Posted on September 14, 2011 by

The Department of Health and Human Services on Wednesday released a final rule implementing Section 6411 of the Patient Protection Affordable Care Act that calls for states to create and maintain a relationship with a “Recovery Audit Contractor” to identify improper payments and … Continue reading →

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