CMS recently announced multiple accomplishments and projects, all designed to reduce fraud and abuse: the Los Angeles office of CMS revoked the billing numbers of 117 providers who had presented false claims or suspicious business operations, saving $200 million, editing the system to stop payment on claims using billing numbers from deceased providers saved another $4 million, and targeted efforts against independent diagnostic testing facilities resulted in revocation of the billing privileges of 83 IDTFs and denied $445 million in claims for “beneficiary sharing.”
CMS also announced that it had expanded its satellite offices in Miami and Los Angeles, “providing additional on-the-ground efforts to identify and report fraud, waste and abuse in Medicare.” In addition, activity in the Miami office has included a cooperative federal/state task force on abuses by independent diagnostic facilities investigating complaints and using site visits, record reviews, administrative actions and data analysis. CMS announced that it and the Florida agencies have referred 400 criminal investigations to law enforcement authorities, revoked the licenses and billing privileges of clinics and practitioners, and added edits to the claims system to “auto deny” claims for medically unbelievable services and flag high-volume claims for particular services. CMS further announced that the U.S. Department of Justice has begun 63 criminal cases and 38 civil cases involving Medicare fraud since October 2005.
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