The Centers for Medicare & Medicaid Services (CMS) has taken the next steps in the agency’s comprehensive efforts to identify improper Medicare payments and fight fraud, waste and abuse in the Medicare program by awarding contracts to four permanent Recovery Audit Contractors (RACs) designed to guard the Medicare Trust Fund.
The country's hospitals offered their support Tuesday for federal legislation that would make changes to the recovery audit contractors program and other national audit programs. FULL STORY »
Virginia selected a recovery audit contractor with experience in the newly authorized fraud detection and prevention program for Medicaid. FULL STORY »
Not-for-profit healthcare organizations face greater scrutiny from government audits than their for-profit counterparts, according to a Health Care Compliance Association survey. FULL STORY »
As scrutiny of healthcare provider payments grows, hospital leaders say regulators are increasingly undercutting physicians' medical judgment and resorting to overly punitive corrective actions. FULL STORY »
Representatives of two federal agencies on Thursday testified about the need to address weaknesses in the Medicare and Medicaid programs, while a CMS official said collaborative efforts with states and a two-pronged strategy have shown promise in preventing fraud. FULL STORY »
The threat of ceaseless auditing and penalties is causing many hospitals to reclassify Medicare patients as less-costly “observation” cases, and the people receiving the care say the confusing change leaves them on the hook for medical bills that the government ought to cover. FULL STORY »
Experts generally agree that a staggering amount of money—between $20 billion and $100 billion—in federal spending on healthcare programs is lost to waste, fraud and abuse each year despite an ongoing crackdown by the government and its private contractors. FULL STORY »
A bipartisan group of six lawmakers from the Senate Finance Committee issued an open letter to healthcare providers, payers and patients seeking input on better ways to prevent waste and fraud in healthcare, including ideas on improving the current audit system for alleged overpayments. FULL STORY »
Senate Finance Committee members plan to issue an open letter to U.S. healthcare providers to broadly solicit advice on the best ways to prevent waste, fraud and abuse in federal healthcare programs. FULL STORY »
Various Medicare and Medicaid auditing initiatives have sharply lowered erroneous excess payments under the programs over the past three years, according to the... FULL STORY »
HMS Holdings Corp., a New York-based benefits coordinator for payers, has signed a definitive agreement to acquire privately held HealthDataInsights, Las Vegas, a recovery... FULL STORY »
By Melanie Evans | October 10, 2011
| Print Magazine
Audits that have turned up more than $680 million so far in Medicare payment errors started slowly in the first year, a new report shows. More recent data suggest auditors have grown more aggressive as the program prepares to expand. FULL STORY »
By Rich Daly | September 19, 2011
| Print Magazine
Hospitals fear Medicaid's new audit program could mean multiple examinations of the same issues from different reviewers, as well as more reviews of the medical necessity of hospital care. FULL STORY »
By Jessica Zigmond | September 14, 2011
| Basic Web
Building on the Medicare Recovery Audit Contractor program, HHS on Wednesday issued a final rule to establish a Medicaid Recovery Audit Contractor program that the agency expects will save $2.1 billion in waste over the next five years. FULL STORY »
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. FULL STORY »
By Jessica Zigmond | May 02, 2011
| Print Magazine
The American Hospital Association said last week that it is pleased the CMS has released data on what it has recouped in improper Medicare payments, but would still like to see information about the appeals process in the agency's recovery audit contractor program. FULL STORY »
By Christine LaFave Grace | April 26, 2011
| Basic Web
The CMS has collected more than $313 million in Medicare overpayments through its recovery audit program since October 2009, according to the CMS' most recent recovery-audit report—and nearly half of that was collected from January through March of this year. FULL STORY »
By Jessica Zigmond | November 05, 2010
| Basic Web
In a proposed rule regarding new Medicaid recovery audit contractors, the CMS said states will be allowed to determine whether to pay their Medicaid RACs on a contingency basis or under some other fee structure that identifies underpayments. FULL STORY »
Senate Finance Committee ranking member Chuck Grassley (R-Iowa) has asked the CMS to list any identified conflicts of interest among the agency's contractors and highlight any steps that CMS has taken to prevent those conflicts. FULL STORY »
The CMS probably paid more than $8 million between 2006 and 2007 for healthcare services rendered after the patients' deaths, a federal audit has found. FULL STORY »
My question is, how much of the recovery included simple coding mistakes—i.e. duplicate lines etc.—that the financial intermediary could have and should have caught? FULL STORY »
It will be interesting to see how this one works out. Most recovery audit contractors are selected via lowest-priced bids. Fees paid to RACs are very low; waiting for payment may cause budget issues for RACs. FULL STORY »
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