RACs' effectiveness exaggerated

Regarding “RACs recouped $3B for Medicare in 2013”:

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 recovery audit contractor 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 administrative law judge 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' efforts to get compliance reform in place.

Frank Cohen