In an effort to combat the waste, fraud and abuse that has cost Medicare and Medicaid billions of dollars over the years, Congress has given CMS and the Health and Human Services Inspector General new and powerful tools to combat an admittedly serious problem. However, the livelihood and reputation of honest and dedicated providers of Medicare and Medicaid services and supplies are at risk as auditors and investigators rush to meet the ever more strident demands to reduce waste, fraud and abuse.
I have for almost 40 years represented providers seeking payment for their services as well as those defending themselves against unjustified repayment demands. I have spent countless hours with the Code of Federal Regulations and the alphabet soup of ever changing entities, programs and policies that make up the world of Medicare and Medicaid billing.
My hope is that this blog will become a one stop resource for those caught up in what I believe will be an ever expanding world of auditors, contractors and investigators requesting from providers more and more information in an effort to justify more and more frequent payment denials and demands for repayment. While this blog cannot stop the denials and demands, it is my hope that the information available here will increase provider understanding of the process, tell a provider what it needs to know about how to present its arguments in the most persuasive manner possible and, at the end of the day, help every honest provider get paid a fair price for its services in a timely manner.
I encourage you to e-mail me any comments, thoughts for posts or questions you might have about the ongoing events in the Medicare-Medicaid Audit World.
David S. Dessen