CMS set to begin delayed anti-fraud programs June 1
Two CMS anti-fraud programs, whose Jan. 1 launch was scrubbed because of provider concerns, will start June 1 instead, according to the agency. One will allow recovery audit contractors to review claims before they are paid, focusing on the types of claims historically associated with high rates of improper payments in seven states (California, Florida, Illinois, Louisiana, Michigan, New York and Texas) and claims with high volumes for short inpatient hospital stays in four states (Missouri, North Carolina, Ohio and Pennsylvania). A pilot program that will require prior authorization for scooters and power wheelchairs prescribed for Medicare beneficiaries, however, was “significantly” redesigned and will launch in California, Florida, Illinois, Michigan, New York, North Carolina and Texas. That pilot will no longer require prior authorization for 100% of the claims for the equipment.