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The Return Of The Medicare Bounty Hunters

By Robert David, Esq.

In the 1990?s there was a system in place that seemed reasonable at the time. The government hired private companies to audit hospital cost reports on the government?s behalf and to add additional incentive, those companies, generally large insurance companies, would receive bonuses based upon funds recovered. This lead to a sort of system where there were "gotcha" games between the auditors and providers, the providers would try and maximize their reimbursement knowing that the auditors would be specifically looking for places to cut. Making matters worse, the auditors tended to ignore ?errors? that benefited the providers because those errors didn?t benefit the government contractors. So too, the providers, in analyzing and contesting the audits through the appeals process would only report ?errors? that benefited the providers...continue to full post

Full post as published by Health Care Fraud Blog on March 04, 2010 (boomark / email).