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DHHS, through its Centers for Medicare and Medicaid Services (CMS) branch, began the program in 2005, using Recovery Audit Contractors to perform the actual work of reviewing, auditing, and identifying improper Medicare payments. At the inception of the program, it focused on Medicare payments in the states of California, New York, and Florida.
Connolly was founded in 1979 by James Connolly, a former executive at the Gimbels department store, and was initially known as Connolly Consulting Associates. The company’s initial focus was on retailers, but the business was expanded to non-retailers in the early 1990s, and to healthcare medical claims auditing in the late 1990s.
The company's services include providing validated insurance and helping find liable third parties. Their program integrity services identify improper payments and over-payments and attempt recovery, as well as reduce fraud and waste. In addition, the company also supports Medicaid Managed Care Organizations and Medicare Advantage Plans. [3]
A prominent plastic surgeon who two years ago paid more than $800,000 to settle claims of improper Medicare and Medicaid billing is now suing a number of his former attorneys, claiming that it was ...
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Under federal whistleblower laws, the plaintiffs will receive 28% of the Omnicare recovery (worth roughly $4.8 million) and 25-30% of the recovery from the Esformes family (worth from $1.25 million to $1.5 million). The Esformes family also agreed to pay almost $1 million in the plaintiffs’ attorneys' fees. [8]
Medicaid estate recovery is intended to help make the program affordable for the government, but it can financially impact the beneficiaries of Medicaid recipients.