RAC reversal rate misleads on audit effectiveness
Regarding the recent article “RACs recouped $3B for Medicare in 2013” (ModernHealthcare.com, Sept. 29), I am a healthcare statistician who works very closely with pre- and post-audit compliance risk and mitigation issues. I would strongly disagree with the validity of the 18.1% reversal rate claimed by the RAC trade group. This number is so low because so few, if any, of the appeals made it to the administrative law judge level in a timely manner where, historically, the reversal rate runs between 72% and 85%, depending on which study you read.
This is a classic tale of how to lie with statistics and grossly exaggerates the effectiveness of the RACs. Because the RACs have done such a dismally poor job, there is a backlog of over half a million appeals waiting for ALJ hearings and a two-year moratorium on even scheduling a hearing. If you really want to get an accurate handle on the reversal rate, wait a couple of years and match the appeals back to the findings in 2013. I am very disappointed to see that number appear like this, because it hurts the efforts of providers and their associations to get compliance reform in place.
Frank Cohen Spring Hill, Fla.