CMS Halts Anti-Fraud Projects Among Heavy Provider Opposition

Modern Healthcare reports that two anti-fraud demonstration projects announced in November by CMS were delayed after they drew heavy provider opposition.

The first project would require pre-authorization for scooters and power wheelchairs prescribed to Medicare beneficiaries in any of the seven states with the highest concentration of fraud or billing errors, including, California, Michigan, New York, Illinois, North Carolina, Florida and Texas. According to CMS, the process of preauthorization was developed to ensure that medical conditions warrant the proper medical equipment.

Recovery Audit Contractor (RAC) authority expansion is the second anti-fraud project, which allows RACs to review claims before they are paid. The focus is on the seven states with the highest rates of improper payments (California, Michigan, New York, Illinois, Texas, Florida and Louisiana) and claims with high volumes for short inpatient hospital stays in four other states.

CMS plans to notify providers at least 30 days before the delayed projects begin.

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