A physician advocacy group is calling on CMS to include safeguards for small independent practices as the agency ramps up its fraud, waste and abuse enforcement efforts, according to an April 6 news release from the Physicians Advocacy Institute shared with Becker’s.
The Physicians Advocacy Institute submitted comments in response to CMS’s CRUSH initiative — Comprehensive Regulations to Uncover Suspicious Healthcare — urging the agency to distinguish between intentional fraud and inadvertent billing errors, which it says could have an outsized impact on smaller practices that lack the resources to absorb aggressive compliance actions.
PAI recommended that CMS ensure transparency throughout enforcement proceedings, allow physicians due process to share information and halt payment recoupment until a final determination is made. The group also called for physician involvement in developing any clinical criteria used in AI-based fraud detection tools.
“When bad actors steal or squander taxpayer dollars, patients lose and government has an obligation to intervene,” Kelly Kenney, CEO of PAI, said in the release. “We know from past experience that auditors sometimes make mistakes, and smaller practices often cannot absorb the financial losses from aggressive compliance actions taken before a final determination is made. Physicians need assurances that they can continue to practice medicine without distractions that would compromise patient care.”
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