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CMS orders physicians to hunt down overpayments


Medscape reports that new rules from CMS say that “physicians must not only return Medicare overpayments within 60 days of identifying them but also actively look for overpayment through self-audits and other forms of research….”

“If a physician fails to hand back overpayments within 60 days, he or she risks getting sued by the government under the False Claims Act (FCA).”

Many physicians, already drowning in paperwork, will not be pleased by this latest CMS mandate.

“This requirement would be extremely burdensome for physicians as it would impose a boundless duty to troll medical records in search of innumerable vulnerabilities,” the American Medical Association and dozens of other medical societies wrote CMS in 2012.

“CMS did not cut organized medicine any slack in its final regulations, but instead said what physicians did not want to hear. The agency also warned that some healthcare providers might avoid self-scrutiny for the sake of not discovering money they would have to return,” the publication reported.

“We disagree that this rule creates a requirement for any formal compliance plan or audit strategy,” CMS said. “Rather, it requires that providers and suppliers maintain responsible business practices and conduct a reasonably diligent inquiry when information indicates that an overpayment may exist.”

Wanda Filer, M.D., president of the American Academy of Family Physicians, one of the signatories to the 2012 letter to CMS, told Medscape that she hopes the agency will “interpret ‘clear duty’ very gently,” lest, as the publications put it, “physicians find themselves with more administrative work that reduces face time with patients”

“Patients have one clear duty, and that’s taking care of patients,” Dr Filer told Medscape.  “CMS has a clear duty to protect the Medicare trust fund. How we strike the balance…will be the art of this.”

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