Corporate Compliance

Note: RAC coding reviews and fraud training

Medicare Weekly Update, March 2, 2010

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This week several transmittals, including the April quarterly OPPS update, were listed on the transmittals page on the CMS Web site.  However, as noted in the transmittals section of the Medicare Weekly Update, we are unable to access the actual transmittal documents. Transmittal numbers appear in the list of transmittals for 2010 and there is some basic information (e.g., subject, effective/implementation dates, etc.), but the links to the transmittal documents are broken.  MedicareFind staff have been in contact with CMS multiple times on this issue but there is no resolution at this time. We will report on the affected transmittals when they are made viewable by CMS.

In other happenings this week, the OIG reported on the fraud referral process, or rather, lack of process, during the RAC Demonstration Project. Although RACs received minimal Medicare fraud training, they did identify and report two provider-specific fraud issues, according to the OIG. However, CMS did not have a record of these referrals when asked by the OIG. The OIG recommended CMS follow up on these two referrals, and they have been sent to the OIG for further investigation.

Continue reading Kimberly's note on RAC coding reviews and fraud training.


 



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