RAC for all
Push for more audits could affect hospitals: experts
An edict from the White House to expand fraud and abuse audits on a governmentwide basis puts the heat on hospitals to keep their shops in order and free of error, some industry experts claim.
Last week, President Barack Obama took a series of steps to cut down on fraudulent activities in Medicare, Medicaid and other government programs, a measure he believes will return at least $2 billion in recovered costs to taxpayers over the next three years. Among other things, he signed a presidential memorandum that would direct federal agencies to “expand and intensify” the use of audits, such as those performed by recovery audit contractors, and Medicaid integrity contractors.
The Recovery Audit Contractor Program allows third-party auditors hired by the CMS to keep 9% to 12.5% of provider payments they identify as improper.
The White House in making its announcement on fraud crackdown efforts specifically cited the RAC pilot program as a success story for these types of audits. The pilot was carried out in several states over three years and recouped more than $992 million in overpayments to providers.
At the moment, it’s unclear whether the RAC or the Medicaid Integrity Program will be affected by the president’s proposal, Don May, vice president of policy with the American Hospital Association, said in an e-mail.
Obama in issuing the memorandum hasn’t necessarily changed the tactics for the RAC or Medicaid auditors, said Robert Corrato, president and CEO of Executive Health Resources, Newtown Square, Pa., which offers medical necessity compliance services.
“What I believe is seminally different now is the president has publicly taken us into the era of healthcare audit accountability,” and that cracking down on fraud and abuse is high on the president’s agenda, he said. “It takes every auditing agency, every contractor that works through the Medicare and Medicaid program and it puts them on notice.”