In 2003, CMS developed the Program for Evaluating Payment Patterns Electronic Report (PEPPER). This program was originally developed to offer confidential, provider-specific data for services vulnerable to improper payment and allowed providers to see how their own facility compared with state and national averages.
A number of stories Billing Alert for Long-Term Care has covered throughout the year have focused on fraud and abuse. Many of these articles have discussed the regulatory steps that the government has taken to uncover improper reimbursement through the Affordable Care Act (ACA), the OIG guidelines that incentivize states to restructure their False Claims Acts, as well as increased rewards for whistleblowers. To some, these interventions were hardly a surprise given that the government recovered nearly $5 billion in False Claims Act settlements in 2012.