Healthcare Business News

RAC program collects $233 million

By Jessica Zigmond
Posted: August 3, 2011 - 3:00 pm ET

The CMS' Medicare fee-for-service recovery audit contractor program collected about $233.4 million in overpayments from March through June of this year, bringing the total of recouped overpayments since October 2009 to about $575.2 million.

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A permanent national program since last year, the RAC program uses four contractors—Diversified Collection Services, CGI, Connolly and HealthDataInsights—to help identify fraud and abuse. The program' third-quarter report (PDF) also showed that the CMS collected about $185.2 million in overpayments for the second quarter and $81.2 million for the first quarter of 2011 that covered the period of October 2010 through December 2010.

Meanwhile, the RAC program returned about $55.9 million in underpayments to providers for the third quarter, which is more than double the $23.7 million in underpayments it returned in the previous quarter. Since October 2009, the RAC program has returned about $109.6 million in underpayments.

This most recent report from the CMS highlighted some overpayment issues in areas that included durable medical equipment, renal and urinary tract disorders, and minor surgery and other treatment billed as inpatient services. “Medicare does not make separate payment for DMEPOS (Durable Medical Equipment, Prosthetics, Orthotics and Supplies) when a beneficiary is in a covered inpatient stay,” the report cited as an example. “Suppliers are inappropriately receiving separate DMEPOS payment when the beneficiary is in a covered inpatient stay.”

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