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Medicare claim auditors blast hospital protection bills

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Congress is considering two bills that could put curbs on the independent auditing contractors who try to find evidence of fraud and abuse in Medicare providers’ bills.

Rep. Sam Graves, R-Mo., introduced H.R. 1250, the Medicare Audit Improvement Act of 2013 bill, in March.

Sen. Roy Blunt, R-Mo., introduced a companion bill, S. 1012, in May. 

The bill tells the U.S. secretary of Health and Human Services (HHS) to put a limit on the number of times that Medicare administrative contractors can ask hospitals to justify their bills.

The bill also would set new standards for claim recovery audit contractors, direct the HHS secretary to publish recovery audit contract performance information on the Web, and require that a physician review any claim that a billed service was not medically necessary.

The American Coalition for Healthcare Claims Integrity — a group of recovery auditors — said implementing the bills would undermine efforts to hold down Medicare costs.

“Recovery audit contractors have found instances where hospitals have submitted claims 10 times the amount of medication that was administered to the patient” and “billed Medicare for durable medical equipment items such as wheelchair when these items were not ordered by a physician,” the group said.

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