Long-Term Care, Home Health & Hospice

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CMS Postpones Two Anti-Fraud Initiatives

Posted on February 6, 2012 in Long-Term Care, Home Health & Hospice

Written by: Bufford, David W.

The Centers for Medicare & Medicaid Services (CMS) has pushed back the start of two anti-fraud programs to June due to provider concerns.  Two pilot programs, one that would require prior authorization for scooters and power wheelchairs and one allowing recovery audit contractors (RAC) to review claims prior to payment, were initially slated to begin January 1, 2012.  

The program to require prior authorization for scooters and power wheelchairs for Medicare beneficiaries has been suspended in its current form and CMS will launch a significantly redesigned version in seven states on June 1.  Those states are: California, Florida, Illinois, Michigan, New York, North Carolina, and Texas.

The second program will allow RACs to review claims before they are paid, focusing on the types of claims historically associated with high rates of improper payments in seven states (California, Florida, Illinois, Louisiana, Michigan, New York, and Texas), and claims with high volumes for short inpatient hospital stays in four states (Missouri, North Carolina, Ohio, and Pennsylvania).  This program also will begin June 1.  Unlike the first program, this program will not be changed, only delayed in the implementation.

Should you have any questions, please contact:
Todd Selby at 317.977.1440 or;
Brian Jent at 317.977.1402 or; or
David Bufford at 502.568.9368 or,
or your regular Hall Render attorney.