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.
November 13, 2009 A controversial audit program in the process of being rolled out in all 50 states by 2010 is sparking concerns not just from the nation's largest hospitals, but the smallest physician practices as well. The Recovery Audit Contractor, or RAC, program was created by the Medicare Modernization Act of... ... FULL STORY
By Matthew DoBias September 24, 2009 States would have up to one year to repay the federal government a share of the money they recoup from fraudulent or improper Medicaid payments, under an amendment approved by the Senate Finance Committee. ... FULL STORY
By Jennifer Lubell September 21, 2009 Hospitals and others in the healthcare industry are expressing trepidation over a provision in the newly released Senate Finance Committee reform bill to expand a controversial Medicare audit program. ... FULL STORY
By Jennifer Lubell August 10, 2009 IPRO, a quality improvement and evaluation organization in Lake Success, N.Y., has been awarded a contract to audit claims and identify potential overpayments under the CMS' Medicaid Integrity Program. ... FULL STORY
By Jennifer Lubell August 06, 2009 Medicare's Recovery Audit Contractor in CMS Region C has posted the first set of issues eligible for audit for outpatient hospital and physician providers in South Carolina, possibly setting a precedent for other RAC audits across the country. ... FULL STORY
By Melanie Evans July 31, 2009 Medicare's three-year pilot project to audit hospital, physician and other provider payments found that CMS overpaid for care by more than $980 million, thanks largely to poor records, billing errors and medically unnecessary care. One of the most frequently cited reason for excess pay to... ... FULL STORY
June 17, 2009 Modern Healthcare reporter Melanie Evans talks with Rudy Braccili Jr., director of the national Medicare and Medicaid center for Tenet Healthcare Corp. subsidiary Conifer Health Solutions, about the Recovery Audit Contractor program during the Healthcare Financial Management Association's... ... FULL STORY
By Jennifer Lubell June 15, 2009 The CMS is attempting to clarify the role of new federal contract audits being performed under Medicaid that providers fear will operate in a similar fashion to the controversial Recovery Audit Contractor program in Medicare. ... FULL STORY
By Jennifer Lubell June 01, 2009 It may be the calm before the storm for providers subject to the Recovery Audit Contractor program. As soon as this week, the first audit letters requesting medical records of hospitals are expected to be sent out to hospitals under the new program. ... FULL STORY
By Jennifer Lubell May 15, 2009 PRG-Schultz International, Atlanta, a subcontractor in the CMS’ Recovery Audit Contractor program, has announced that its treasurer and chief financial officer, Peter Limeri, will be resigning on May 31. ... FULL STORY
By Jennifer Lubell May 04, 2009 The American Hospital Association has developed a new tool that seeks to bulk up its lobbying power in proposing any changes to Medicare’s controversial Recovery Audit Contractor, or RAC, program. ... FULL STORY
By Jennifer Lubell April 23, 2009 The American Hospital Association has released an advisory to members on Medicare’s Recovery Audit Contractor program discussing the contingency fee percentages that will be paid to each contractor. ... FULL STORY
By Jennifer Lubell March 27, 2009 A San Diego health system has filed a complaint in federal court, challenging procedures used by Medicare’s recovery audit contractors to reopen claims. The suit, filed by two-hospital Palomar Pomerado Health against HHS, alleges that RAC contractor PRG-Schultz International unlawfully reopened a... ... FULL STORY
By Jennifer Lubell March 09, 2009 The Recovery Audit Contractor, or RAC, program, has caused a great deal of controversy, yet the CMS wants to make its new audit process “a fair program” for providers, said Lt. Terrence Lew, a health insurance specialist with the CMS’ Division of Recovery Audit Operations’ Financial Services Group,... ... FULL STORY
By Jennifer Lubell February 16, 2009 Hospitals in certain states may have new reasons to be wary of the Recovery Audit Contractor program. ... FULL STORY
By Jennifer Lubell November 10, 2008 Hospital executives anxious about complying with Medicare’s Recovery Audit Contractor program may have breathed a temporary sigh of relief last week in hearing that the audit contracts had been suspended because of a protest action issued by two contractors. ... FULL STORY
November 04, 2008 Actions taken by two contractors that unsuccessfully bid to be part of Medicare’s permanent Recovery Audit Contractor program have led to a suspension in RAC activities, the CMS reported. ... FULL STORY
By Jennifer Lubell October 13, 2008 Gotcha! That’s the word that Gerald Worrick, president and chief executive officer of 25-bed Door County Memorial Hospital, in Sturgeon Bay, Wis., uses to describe the new federal Medicare Recovery Audit Contractor program that was officially unveiled last week. ... FULL STORY
August 11, 2009 After reading the article “One-day stays a big reason for excess pay to hospitals, RAC project finds,” if I were a consumer of services, I would want to know specifically the criterion for determining either hospital admission or outpatient procedure determination. ... FULL STORY
May 07, 2009 Carriers are picking on one or two claims pertaining to down-coding of medically necessary office visits. It costs the provider more to fight one claim of $120 but the physician feels obligated to do this to protect his integrity of coding. ... FULL STORY
November 10, 2008 If the answer is transparency, the germane and honest question is “for whom?” The revised Pharmaceutical Research and Manufacturers of America code (along with recent announcements by Eli Lilly and Co., Merck & Co. and others that they will make public their financial relationships with... ... FULL STORY
October 13, 2008 The concept here is good, however, the CMS has failed miserably in placing proper oversight on these contractors. While the existing contractors have made significant gains in recovery, they are also responsible for a significant increase in the appeals from doctors who feel that the decisions are... ... FULL STORY
