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Medicare Audits Recover $162 Million So Far This Year

  
  
  
  
Medicare audit lawyer
The Centers for Medicare & Medicaid Services (CMS) has collected $162 million in Medicare overpayments during the first quarter of 2011.  According to a recent CMS report, the CMS Recovery Audit Program has recovered $313.2 million in Medicare overpayments since 2009, and over half of that amount was recouped during January through March of this year.  According to the report, the top overpayment issues involved issues of incorrect coding and billing for bundled services separately. 

CMS Recovery Auditors

Medicare Recovery Audit Contractor (RAC) Program

  
  
  
  

In 2006, Medicare inappropriately paid a total net $178 million (out of $466 million) for chiropractic claims for services that were maintenance therapy ($157 million), mis-coded ($11 million), or undocumented ($46 million).  Another study indicated that 83% of all chiropractic claims failed to meet one or more of the documentation requirements.  Of the 76% of records that reviewers indicated contained some form of treatment plan, 43% lacked treatment goals, 17% lacked objective measures, and 15% lacked the recommended level of care.  A medical reviewer indicated, “in my twenty-nine years of practice, I rarely saw documentation of a plan which included frequency, duration, goals and objective measures.  While these guidelines are in the Medicare manual, they apparently have not been incorporated into the profession.” 

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