How ‘pay and chase’ works

Las Vegas Review-Journal (Sunday) - - FROM THE COVER -

In fis­cal 2017, state Med­i­caid pro­cessed just un­der $567,000 in pay­ments to providers through a spe­cific case man­age­ment billing code used in be­hav­ioral health. The next year, use of that code sky­rock­eted.

Med­i­caid in­ves­ti­ga­tors be­gan ex­am­in­ing the billings to see if providers were us­ing it to sub­mit fraud­u­lent bills. They reached out to providers and gave them a chance to seek ed­u­ca­tion through Med­i­caid if it was clear the im­proper billing was un­in­ten­tional.

At the end of the process, Med­i­caid re­cov­ered $6.3 mil­lion in im­proper pay­ments — more than 1,000 per­cent more than they clawed back in that cat­e­gory the pre­vi­ous year.

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