By Dan Henley – October 31, 2016

AB 1244 and SB 1160 support anti-fraud efforts of Prosecutors, the Department of Insurance and District Attorneys but the Governor did not abolish fraud with a pen.

Under AB 1244, the Administrative Director may suspend any provider if: proper licensure has been surrendered or revoked, the provider has been suspended by Medicare or Medi-Cal or when convicted of a crime involving the practice of medicine. And SB 1160 stays proceedings and accrual of interest upon the filing of criminal charges involving medical fraud. Assignment of receivables will be once again be restricted.  A new Lien Affidavit required as of July 1, 2016 will create prerequisites to define legitimate lien disputes.

Liens have not stalled. A Compound Pharmacy that may meet these criteria filed over $1 million in new liens this year alone. While new regulations and court protocol are developed, lien volume and current WCAB procedures pressure payers for settlement or protracted litigation.  The WCIRB estimates $12.2 million annual savings from these new anti-fraud statutes.  We cannot rely on the AD or DWC alone.  Providers change physical location, TIN, name, corporate structure or join different entities, yet continue business as usual.  Tracking changes is daunting.  Remember, you heard in here first.

Late model anti-fraud and abuse vehicles require a driver, a route and a destination. Fortunately, CostFirst has cleared the way to discern between liens to be negotiated or resisted. Our work in the past 11 years with employers, insurance carriers and law enforcement produced CUBETM powered by HEATTM, the high performance engine for the race against fraud and abuse.  Arrange for a demonstration of innovative CUBETM powered by HEATTM a vital part of CostFirst’s deluxe brand and streamlined lien defense that aligns technology, provider analysis and expert bill review to determine reasonable charges for necessary treatment by qualified providers.