“This documentary offers an example of the real-life consequences of a federal government audit program that is out of control,” said Robert W. Seligson, executive vice president and CEO of the NCMS. “Federal audit contractors are paid to find problems, extrapolate the findings and increase the fines to exorbitant amounts, which can lead to medical practices closing their doors, especially in rural communities already facing critical primary care physician shortages.”
The documentary describes a series of events, beginning with a medical records request, that resulted in the Centers for Medicare and Medicaid Services (CMS) imposing a fine on ECIM of more than $1 million. The Medicare Program Safeguard Contractor (PSC) took minor errors alleged in the medical charts and extrapolated $40,000 to reach the overpayment amount of $1 million. After two years, thousands of dollars in legal and administrative expenses and a severe impact on access to patient care, ECIM proved that it had provided the appropriate services to its patients and had documented claims correctly. The original fine was reduced to less than $4,000 only after ECIM physicians and staff spent three days with an administrative law judge reviewing each claim in question. It even took US Senator Richard Burr (R-NC) contacting CMS directly in order for ECIM to receive the money owed back to them.
The NCMS and PAI hope to urge the federal government to take steps in addressing the flawed audit system and help physician practices understand the importance of appealing adverse audit findings. For a copy of the video, contact the NCMS at 919-833-3836 or 800-722-1350. Members can also refer to the NCMS Health Care Audit Resource Center for more information on how to prepare for and address medical audits. PAI will be hosting the webinar “Medical Audits: What Physicians Need to Know” on Tuesday, May 15, 2012, 2:00 pm, which will provide information about different types of audits faced by physician practices. Principal author of PAI’s recently published white paper, “Medical Audits: What Physicians Need to Know,” Frank Cohen, MPA, MBB, will present the webinar. Click here to register. Look for more medical audit learning opportunities in future issues of the Bulletin.