Lawmakers question California Medicare audits

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 in The Sacramento Bee (reg. req.)

Related Articles:
California hospitals accused of over billing Medicare. Report
Doctor sues Connecticut after Medicaid fraud allegation. Report