Lifecare Management Partners

As prime contractor, Lifecare was awarded a CMS task order to support CMS and the Office of Inspector General's review of nebulizer drug payments in 17 states. Phase 1 of the task order required creating a comprehensive database; receiving and reviewing medical record source documents, notes from beneficiary interviews, and commentaries from medical providers; analyzing findings; and calculate a payment error rate based upon the findings. Phase 2 involved a focused review of the top dollar durable medical equipment (DME) suppliers in three states. In Texas, Lifecare conducted all beneficiary, provider, and DME supplier interviews and collected all other applicable data including the medical records, and then accumulated data from two additional states where the OIG and CMS conducted the same processes, populated a consolidated database of findings, analyzed the results, and calculated another payment error rate. The OIG issued an extensive report identifying the problems and dollars associated with each area of concern, and both OIG and CMS publicly acknowledged the work contributed by Lifecare to the effort. Based on the medical and document review by Lifecare, the OIG estimated that 60% of the $224 million in payments made by the Region C DMERC for inhalation drugs was either unallowable or not sufficiently documented to determine their allowability in accordance with Medicare requirements. Other outcomes of the effort resulted in Lifecare generating 10 fraud alerts based on the medical reviews, public record searches and interviews and developing a comprehensive lessons learned report. As a subcontractor on four PSC contracts to AdvanceMed Corporation, Lifecare has staffed Chief Legal Counsel, Senior Fraud Investigator, Senior Data Analyst, and Utilization Management and Benefit Integrity Manager positions. Its functions have ranged from data analysis, drafting joint operating agreements, report writing, developing fraud leads, making oral and written presentations to law enforcement as part of their case ...