Frank A. Rubino, ESQ.

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Florida Tests New Medicare Payment System

Florida is the lone testing ground in America for a new program for certain types of Medicare hospital payments. As a well known hot bed for Medicare fraud, Florida was chosen by government officials to determine if the new method could reduce the number of improper payments made under the system. The program targets heart operations and a few other specific medical procedures that are commonly used in health care fraud schemes. This particular program requires that all payments for these particular treatments be pre-approved by Medicare contractors.

There are 15 procedures that are currently on the pre-approval list. These include heart procedures such as pacemaker and defibrillator implantation, as well as the placement of stents to combat heart ailments. Medicare suffers an 8.6 percent error rate. That error rate is attributable both to mistakes in billing, and to intentional schemes to defraud the program. The government has asked all 50 states to seek methods by which this error rate can be reduced. Florida, alone, has instituted pre-approving claims.

It is not clear how health care facilities and medical professionals feel about this new plan to reduce improper Medicare claims. While it is beneficial to know that Medicare will make payments for the procedures that get pre-approval, there may be many situations where a hospital is left holding the bag for providing necessary care to deserving patients.

This program is one of the ways in which Florida is seeking to curb Medicare spending. Investigators and prosecutors are devoting significant time and resources to prosecuting people suspected of Medicare fraud. Pre-approval may reduce the number of criminal actions pursued in connection with Medicare claims. It will be interesting to see the impact of the state's efforts to curb improper Medicare payments.

Source: San Francisco Chronicle, "Medicare Pre-Payment Plan Limited to Florida So Far, Group Says," by Michell Fay Cortez and Alex Wayne, 5 December 2011

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