Health Information Management

News: Compliances breaches point to CDI importance

CDI Strategies, December 24, 2009

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$3.75 million. That’s the amount California HMO Kaiser Permanente plans to pay the government for submitting inappropriate claims, The Los Angeles Times reported earlier this month. Certain Kaiser facilities claimed teaching physicians provided treatment to Medicare and Medi-Cal patients that were actually provided by unsupervised residents—an error Kaiser calls a ‘record keeping’ issue.

In November, The Washington Post reported that the government paid more than $47 million in questionable Medicare claims in fiscal year 2009—nearly three times more than the estimated amount from the year before, and the largest waste of taxpayer dollars in the $440 billion Medicare program’s 20 year history, according to the report.

The AP attributed part of the increase to “the Health and Human Services Department’s stricter documentation requirements,” not an actual rise in Medicare fraud. Nevertheless, such revelations point to the ongoing importance of CDI programs that help ensure the completeness and accuracy of medical records before are passed on to the coding and billing departments, before errors become potential targets for RAC review or fraud investigations.

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