News-At-A-Glance

ABN Instructional Tool: Noridian Administrative Services has a new interactive document that serves as both instruction and tutorial for the Advanced Beneficiary Notice of Noncoverage (ABN) Form CMS-R-131. The tool will serve as an aid to assist providers and suppliers with completing the ABN form and appears to have many applications, such as training new employees in the use of the form, training physician offices, and training other users of the ABN when they are using it for laboratory services. It can also be used in remote sites, such as patient service centers, if a computer or mobile tablet device is available to handle documents in that format. The form and instructions can be found at https://www.noridianmedicare.com/parta/train/education_center/media/abn_tutorial.html. To use the form, simply click on an area of the form and the instructions will pop up. 2012 a Record for False Claims Recoveries: False Claims Act (FCA) cases returned over $9 billion to the government in 2012, according to Taxpayers Against Fraud ( www.taf.org). These recoveries come from criminal fines, large state false claims act settlements, and federal settlements. According to Kristin Amerling, president of TAF, health care fraud still represents the bulk of FCA recoveries at both the state and federal level. Of the top 30 FCA cases in 2012, 19 were related to health care. What is most interesting about the statistics is the fact that all but two were initiated by whistleblowers. TAF notes that qui tam cases work well because whistleblowers bring hidden information to the government’s attention and the lawyers who work with the whistleblowers act as “force multipliers.” More importantly, unlike a government hotline, False Claims Act whistleblower cases must be investigated; they cannot be ignored. The government’s FCA enforcement efforts in the health care arena have been directed at recovering government funds paid for services billed but not provided; services provided but not provided as billed; services provided but not billed in compliance with statutory and/or regulatory requirements or administrative guidelines; or services rendered and appropriately billed, but not provided in accordance with underlying statutory, regulatory, or contractual obligations.