RAC for all

Push for more au­dits could af­fect hos­pi­tals: ex­perts

Modern Healthcare - - The Week In Healthcare - Jen­nifer Lubell

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.”

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