Error Rate Among Medicare Auditors High

Recovery Audit Contractors (RAC) have recovered more dollars in 2011 than they did in 2010 but this metric of success may overstate their value.

A Washington Post story from yesterday, November 14 2011, shows that Medicare auditors make overpayment determinations based on "inaccurate data".

RAC activity in 2011 was centered in the West and the Southern United States.

State	Overpayment
Florida	$7.1 million
California	$7.7 million
Washington	$5.3 million
Texas	$5.8 million

"The error rate in the Medicare RAC process is disturbingly high, especially since the cost of filing an appeal can be prohibitive," said AMA President Peter W. Carmel, MD.

"The AMA is working with CMS to improve this process and decrease the financial and administrative burden on physicians."

A 2010 Office of the Inspector General (OIG) report found that CMS...

"...did not sufficiently oversee the RACs during the demonstration project to ensure the vulnerabilities pursued by RACs were valid and that RACs made accurate improper payment determinations.

According to provider associations, this led to numerous appeals of inaccurate RAC determinations that were expensive and burdensome for providers."

Physical therapists can reduce their risk of a RAC audit, or any Medicare audit by following the seven components of the OIG Compliance Program for Individual and Small Group Physician Practices.

Also, join the email tutorial in the sign-in boxes above or below this post.

Medicare Uses "Inaccurate and Inconsistent Data" to Audit Providers

The Washington Post reported today that...

"Medicare contractors are paid tens of millions of taxpayer dollars to detect fraudulent Medicare claims are using inaccurate and inconsistent data..."

The Washington Post is reporting on an unreleased report by the Office of the Inspector General (OIG)...

"The U.S. Department of Health and Human Services inspector general’s report — obtained by The Associated Press before its official release — found repeated problems among the fraud contractors over a decade and systemic failures by federal health officials to adequately supervise them."

The Recovery Audit Contractors (RAC) auditors were implemented in 2007 in Florida, California and Texas to solve these problems.

"CMS has repeatedly said the latest system of fraud contractors was designed to fix the problems with earlier contractors and allow the agency to better monitor them."

These RAC auditors are currently auditing physical therapists, physicians and hospitals.

"The same issues were identified 10 years ago by inspector general investigators, and dozens of reports in the past decade also have found problems.

In 2001, acting Inspector General Michael Mangano testified that the Centers for Medicare Medicaid Services (CMS) wasn’t doing a good job of holding contractors accountable."

I hope someone is auditing the auditors.