Archive for Wednesday, January 14, 2009

Doctors’ group criticizes claim that physicians improperly billed Medicaid

January 14, 2009


— The Kansas Medical Society on Wednesday strongly criticized a recent state audit that alleged numerous suspicious billing claims in the state’s Medicaid program.

Jerry Slaughter, executive director of the nearly 5,000-member KMS, told a legislative committee that the report by the Legislative Division of Post Audit contained serious deficiencies and unsupported allegations.

The audit did “a disservice to the hard-working primary care physicians of this state who serve the Medicaid population,” he said.

The audit questioned approximately $13 million in Medicaid expenditures. Medicaid is the state and federal taxpayer-funded health care provider for low-income residents. The program costs about $2.5 billion each year in Kansas.

Slaughter said one part of the audit suggested nearly 25 percent of claims for physician office and emergency room visits had been “upcoded,” or billed Medicaid for a more costly service than was actually provided.

Slaughter said the allegation was without merit because auditors didn’t examine any medical records associated with the claims, nor did the audit staff have any medical expertise.

The audit used a method called “data mining” that looks for statistical data that may identify potentially unusual claims.

Scott Frank, audit manager for the Division of Post Audit, said the purpose of the audit wasn’t to make allegations of fraud but to raise red flags for state health officials to investigate further.

“We think it does point to areas where there are potential problems,” Frank said. “We were careful to say we didn’t identify fraud.”

The audit has stirred controversy since its release last month.

The Kansas Health Policy Authority, which administers Medicaid, has been critical of the report.

After hearing a presentation on the audit and then from Slaughter, state Sen. Jim Barnett, R-Emporia, and chairman of the Senate Public Health and Welfare Committee, said the audit was incomplete.

“If they’re really interested in drilling down to find out if there is fraud and abuse or upcoding of services, they need to actually open medical records and look at the charts,” said Barnett, who is a physician. “They also need to have someone who is doing the audit with expertise in health care.”


KS 9 years, 3 months ago

The State of Kansas does not care on issues like this. The doctors, like many other medicaid providers are guilty until NEVER proven innocent. Recoup, recoup and recoup. They do that in an attempt to cover up their mistakes with the Federal Govt. on Kansas biling errors. My advice to the doctors is to stop being a medicaid provider. Like is too short.

merritr 9 years, 3 months ago

It seems the purpose of the audit was not to detect fraud, but to find some red flags. I didn't see it as an indictment against KS physicians, or anyone else. There does need to be medical experts involved to see if the coding was done improperly. If so, were the mistakes deliberate. From what little we've seen of it, it doesn't look like the mistakes were deliberate; hence, no fraud. So there shouldn't be much arguing going on. Do a more thorough audit, if you think it is worth the taxpayer money, and then we can look at possible cases of fraud. Since the errors constitute less than 1% of the budget, I'm not sure it's worth looking into.

jafs 9 years, 3 months ago

Right,The question would be how much of our resources are being spent on these investigations.Especially with so much unregulated stuff going on that costs us a lot more money.

Sharon Aikins 9 years, 3 months ago

My parents have mentioned a couple of times lately of Medicare being charged for tests that were never done. My mother went to an emergency room not long ago, they did a blood test and observed her yet the bill showed xrays and other tests that were not done. I'm sure it happens all the time and, even if reported, it is easier to ignore these than to launch a full scale investigation. I think those who abuse go just close to the line but not far enough over to make it seem worth the time to spend big bucks trying to find all the guilty parties.

Linda Aikins 9 years, 3 months ago

Are the mischarges being reported to the doctors office? Or to Medicaid? If the people who have the errors on their bill let Medicaid know, rather than relying on audits, then the overhead for reporting should be lower, right?If the charges are xrays and tests, it could be that the overcharge is $500 or more? That would be worth the time to report, I would think.

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