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California Hospital Association wants audit of auditor

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Department of Health and Human Services (HHS)
Centers for Medicare and Medicaid Services (CMS)
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In recent months, the California Hospital Association has vigorously challenged the high volume of Medicare denials issued by CMS contractor PRG-Schultz International. PRG-Schultz is part-owned by a company controlled by Richard Blum, husband of Sen. Dianne Feinstein (D-Calif.), a fact which has made the controversy hotter.

Now, the California Hospital Association has asked the Inspector General of HHS to investigate PRG-Schultz, which to date has rejected more than $100 million worth of Medicare claims from rehab hospitals. CMS acting administrator Leslie Norwalk is defending PRG-Schultz, contending it has followed Medicare law.

The CHA, meanwhile, questions whether the 20 to 25 percent bounty PRG-Schultz gets on each denied claim has caused it to reject the majority of rehab hospital care claims. These bonuses, part of a practice known as recovery auditing, is also being tested in Florida and New York, but in those states the contractors are not-for-profit organizations.

To find out more about the controversy:
- read this Sacramento Bee article

Related Article:
Calif. hospitals accused of overbilling Medicare. Report
Judge rejects hospitals' suit against chain in New Jersey. Report

Comments

In 2003 CMS denied a lot my claims I dilegently submitted requested information. In 2004 my billing n. was revoked. I have submitted applications for reactivation and the inspector has submitted false report on more than a few occassions. The latest lie submitted was that he came to condult the inspection and no one was there or the business was closed. I submitted several complaints and I am told I have no appeal rights to the decision made and I must submitt another application. I sent in pictures of the store inside and out, because when I picked the site Notice off of the ground between the store's wood door and screen. I walked to his vehicle and asked was he the inspector? As we we walking back to store from where he parked next door, I asked why didn't he try and know or turn the knob? The inspector said "I wasn't sure this was at the right place". I gestured to the large arrow white sign with red letters baring company's Name, hours of opertation, and telephone number above our head . The Notice was dated on 17th of June but the date of his visit was the 18th. In the pictures I sent to the analyst at NSC included 2 volunteers accessing the store on ramp, and inventory of supplies on display. I also sent a letter of complaint to the Inspector General, Administative Law Judge, Attorney General. I realized with absolute certainty that my company was being discriminated against and maliciously prohibited from obtaining reactivation of my billing number. On December 11, 2007 I received a letter from NSC informing me that my application was denied because of alleged site visits that did not occur, sent to Houston address. I also received a letter dated December 11, 2007 sent to Sugar Land address (denied in August) informing me that my application was denied because I did not submitt requested information in a timely manner. I have proof that I as a DME provider was compliant at the time of application process. The processing time is suppose to be 60 days to complete. However for my company it takes 120 days to process based on application process from 12-2006 to 12-2008. I would like to know of other similar circumstances. Please give me a call @(281) 835-0203, (281) 903-0298.

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