Medicare Compliance Auditing in the Los Angeles Area

In the past few years, several prestigious Los Angeles area hospitals were audited for Medicare compliance, and didn’t pass the test. Cedars-Sinai Medical Center is among many healthcare facilities which failed to stick to federal Medicare billing codes in many instances, resulting in millions of dollars in mass overpayment. If you run a medical private practice in Encino, Los Angeles, or Beverly Hills, then it’s crucial to avoid some of these insurance billing errors. Listed are some of the results of Medicare and Medicaid compliance audits which were conducted on hospitals of the Los Angeles areas, plus some tips for preventing mishaps in your own medical office space.

Cedars-Sinai Medical Center

8700 Beverly Blvd., Los Angeles, California 90048 (310) 4-CEDARS (423-3277) Cedars-Sinai Medical Center is in Los Angeles, close to Beverly Hills and West Hollywood. In May 2013, the Center for Medicare and Medicaid Services filed this audit, claiming that out of 490 inpatient and outpatient claims for Medicare, the LA hospital was only compliant in their response to 81 cases. The remaining 409 claims were not filed in compliance with Medicare billing standards, resulting in a combined overpayment of over $2 million between the years of 2008 through 2011 alone. How did such a vast error in billing occur? According to the government agency, the Los Angeles medical center failed to implement efficient control measures to prevent such Medicare billing errors. Medical Office Remodeling: Top 10 Design Features You’ll Need  

UC Irvine Medical Center

101 The City Drive South, Orange, California 92868 (714) 456-7890 Ranked by the U.S. News & World Report as one of the best hospitals in the nation, including among the highest ranked hospitals in the Los Angeles and Orange County areas, the UC Irvine Medical Center was found non-compliant in their Medicare billing practices, having neglected to file for certain drug injections which were given to patients. In November of 2013, a government audit  indicated overpayments of $50,000.

Southern California Renal Disease Council, Inc

(ESRD Network 18 of Southern California) 700 N. Brand Blvd., Ste. 370, Glendale, California 91203 (888) 268-1539, or toll-free: 1-800-637-4767 Between 2002 and 2006, the Southern California center for kidney disease were found responsible for sums totaling $29,000 in salaries, travel fees, and non-essential spending that didn’t concur with  Medicare billing coding. They had to pay back the amount, plus resolve a $658,000 fine which was implemented by the CMS, according to this government audit.

Get tips on Medicare compliance

If you run a medical facility, such as a plastic surgery center in Los Angeles, or a dental office in the Agoura Hills area, it’s important to make sure that all aspects of management meet these crucial Medicare or Medicaid compliance criteria. When remodeling or building from scratch, look for a medical contractor that specializes in Medicare compliance. Also, CMS.gov has a helpful FAQ page regarding Medicare Contracting, specifically for health care providers. You can learn more about Medicare Contracting Reform and how it will affect fee-for-service programs and Medicare beneficiaries. Please tell us… If you run a medical practice in Los Angeles, are you more likely to seek help on Medicare compliance billing, based on this article? Do you need help finding a medical construction contractor that meets Medicare compliance standards? lease leave your comments below. Share with your friends! If you found this article helpful, then please share with your friends, family, and coworkers by email, twitter, or Facebook. Like this? Read more: Competitive Bidding on Medicare Equipment for 2013 Prevent Medicare Fraud Accusations – 10 Helpful Tips Medicare 2013 – What to Expect  Image courtesy of Stuart Miles/freedigitalphotos