The current emphasis on combating fraud and abuse in the Medicare and Medicaid programs means that providers, including hospitals, nursing homes, home health agencies, clinics, ambulatory surgery centers, laboratories, and medical practices are under greater scrutiny than ever. Audits, inquiries, and investigations by federal and state government agencies, and private firms such as Recovery Audit Contractors who work under contract to government agencies, are proliferating. As such, in today’s environment, there is seldom such a thing as a “routine” audit, and certainly no such thing as a “routine” investigation.

Consider these facts. As we have explained in a prior column, the Patient Protection and Affordable Care Act (PPACA) enacted last year made important changes to the Medicare and Medicaid fraud and abuse laws. PPACA also added more funds for anti-fraud efforts. For fiscal year 2010, the federal government allocated to the Health Care Fraud and Abuse Control Account $1.17 billion in base funding and $311 million in discretionary funding. However, PPACA added $350 million to the account over the next six to 10 years. In addition, last month President Barack Obama included in his proposed budget for fiscal year 2012 another $581 million in discretionary funding for audits, investigations and anti-fraud efforts.

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