A Medicare auditing firm part-owned by the husband of a U.S. Senator has come under intense scrutiny by the California state legislature, dogged by claims that it's rejecting claims unfairly just to make profits for itself. The company, PRG-Schultz International, is contracted with CMS to examine reimbursements and identify inappropriate payouts. PRG-Schultz gets 30 percent of any overcharges it finds. The California Hospital Association has said that PRG-Schultz is on a rampage, rejecting nearly all of the claims rehab hospitals made for post-knee and hip-rehab care since 2002. What makes this a bit more controversial is that the investment firm owned by the husband of Sen. Dianne Feinstein (D) has a substantial financial stake in the company. Members of California's House of Representatives plan to issue a letter asking CMS to investigate PRG-Schultz's activities in the state. Feinstein has already issued a similar letter. CMS officials, meanwhile, have already come out to defend PRG-Schultz, which they say is simply enforcing neglected regulations.
To find out more about the controversy:
- read this piece [1] in The Sacramento Bee (reg. req.)
Related Articles:
California hospitals accused of over billing Medicare. Report [2]
Doctor sues Connecticut after Medicaid fraud allegation. Report [3]
Links:
[1] http://www.sacbee.com/111/story/185989.html
[2] http://www.fiercehealthcare.com/story/calif-hospitals-accused-of-overbilling-medicare/2005-12-19
[3] http://www.fiercehealthcare.com/story/doctor-sues-ct-after-medicaid-fraud-allegation/2006-12-19