Medicare Remains "High-Risk" Program

Monday, March 4, 2013

By Lance O. Leider, J.D., The Health Law Firm

A report released by the Government Accountability Office (GAO) on February 27, 2013, announced that Medicare will remain a "high-risk" program with respect to its fraud and waste vulnerability.  The GAO cites the inability of the Center for Medicare and Medicaid Services' (CMS) inability to reduce the rate of improper payments released by the agency as the reason for its ruling.

Click here to view the full report from the GAO.

Auditors Will Now Be Working Overtime.

In 2012, according to the report, CMS let more than $44 billion in improper payments go out.  This amount is more than half of the total sequestration cuts currently facing Congress.  This means that providers should expect that CMS and its auditors (Zone Program Integrity Contractors or ZPICs, Recovery Audit Contractors or RACs, Medicare Administrative Contractors or MACs, etc.) will be redoubling their efforts to recover every dollar they can.

Health Care Professionals: Be Proactive to Avoid Audits.

Health care professionals need to immediately evaluate their documentation and billing procedures to ensure full compliance with all regulations governing their respective specialties. 

The time to prepare for an audit is before it happens.  As anyone in health care knows, an ounce of prevention is worth a pound of cure.  Review your processes with an experienced health care attorney to be sure that you will not be on the receiving end of a huge overpayment demand. For tips on how to respond to a Medicare audit, click here.

Don't Wait Until It's Too Late; Consult with a Health Law Attorney Experienced in Medicare and Medicaid Issues Now.

The attorneys of The Health Law Firm represent healthcare providers in Medicare audits, ZPIC audits and RAC audits throughout Florida and across the U.S. They also represent physicians, medical groups, nursing homes, home health agencies, pharmacies, hospitals and other healthcare providers and institutions in Medicare and Medicaid investigations, audits, recovery actions and termination from the Medicare or Medicaid Program.
For more information please visit our website at or call (407) 331-6620 or (850) 439-1001.


Now that you know Medicare auditors will be doubling their efforts, what steps will you take to evaluate your documentation and billing procedures? Please leave any thoughtful comments below.


Ballasy, Nicholas. “GAO: Medicare Remains ‘High-Risk’ for Over $44 Billion in ‘Improper Payments’.” Daily Caller. (February 27, 2013). From:

King, Kathleen and Yocom, Carolyn. “GAO’S 2013 HIGH-RISK UPDATE Medicare and Medicaid.” Government Accountability Office. (February 27, 2013). From:

About the Author: Lance O. Leider is an attorney with The Health Law Firm, which has a national practice. Its main office is in the Orlando, Florida, area.  The Health Law Firm, 1101 Douglas Avenue, Altamonte Springs, Florida 32714, Phone:  (407) 331-6620.

Tag Words: Medicare, Medicare fraud, Medicare audit, Center for Medicare and Medicaid Services (CMS), Zone Program Integrity Contractors or (ZPIC), improper payments, overpayments, underpayments, Government Accountability Office (GAO), High-Risk list, defense attorney, defense lawyer, Florida Medicare defense attorney, Florida Medicare defense lawyer, Florida health care attorney, Florida health care lawyer

The Health Law Firm" is a registered fictitious business name of George F. Indest III, P.A. - The Health Law Firm, a Florida professional service corporation, since 1999.
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