A House bill introduced by Reps. Lois Capps (D-Calif.) and Devin Nunes (R-Calif.) would place a one-year moratorium on Medicares controversial Recovery Audit Contractor program.
The legislation would specifically require the CMS and the Government Accountability Office to evaluate the program during the moratorium and report to Congress on their findings. Once the program resumed, the CMS would be required to submit quarterly reports to Congress. No companion legislation has been introduced in the Senate.
Recovery audit contractors review Medicare claims to identify improper payments to hospitals. The program started as a demonstration project but was made permanent by the Tax Relief and Health Care Act of 2006 and operates in five states. Contractors get to keep a percentage of the improper payments they collect from providers. This bounty hunter type of payment mechanism gives contractors incentives to deny claims that appear at all questionable, the American Hospital Association stated in comments to the CMS.
The CMS announced Oct. 19 its intent to expand the program to all 50 states by March 2008. In a revision issued Wednesday, however, the agency scaled back that number to only 15 new statesfor a total of 20 by March, said Don May, vice president for policy at the AHA, in an interview. Most of the remaining states will be phased in by January 2009 or later. -- by Jennifer Lubell
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