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Auditors Getting a Portion of Medicare Payments Recovered

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Private auditing firms have gotten back more than $690 million in overcharges paid by Medicare, and under a new program that's irking health care "providers," the companies that identify the overpayments are getting a portion of the monies they recover, the Wall Street Journal reported.

The program has identified about $1.03 billion in "improper" payments over three years, mostly in New York, California and Florida, the newspaper said. About $992.7 million was in overpayments.

Industry groups representing the providers, mostly hospitals, call the new program an overaggressive "bounty hunter" arrangement. Nonetheless, the Centers for Medicare and Medicaid Services (CMMS) said it is planning to expand the program nationwide, the Journal reported.

Just over $187 million has been paid to the auditors, and some $60 million more was reclaimed by providers who successfully challenged the auditors' findings. That left about $694 million that has been returned to Medicare, the newspaper said.

The CMMS said the auditors don't get paid if their findings are successfully appealed, and they are paid using the same formulas whether they identify Medicare overpayments or underpayments.

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