Medicare claim auditors blast hospital protection 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.

See also:

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• Actuaries: PPACA may have mixed effects on costs
• HHS focuses on risk pool waste and fraud