The Medicare Recovery Audit Contractor (“RAC”) program has a strong supporter in President Obama. On March 10, 2010, Obama signed a White House Memorandum, which states his support of the use of “high-tech bounty hunters,” such as RACs and Medicaid Integrity Contractors (“MICs”), to help root out health care fraud in government-run Medicare and Medicaid […]
The Office of Inspector General (OIG) released a report discussing some of its recent findings regarding the Recovery Audit Contractor (RAC) 3-year demonstration program. The report revealed that between March 2005 and March 2008, the RACs “referred two cases of potential fraud to the Centers for Medicare & Medicaid Services (CMS). However, CMS reported that […]
On December 28, 2009, the American Society of Nuclear Cardiology (ASNC), joined by the American College of Cardiology (ACC), the Florida ACC Chapter, the Association of Black Cardiologist, and the Cardiology Advocacy Alliance, filed a complaint, as well as motions for a preliminary injunction and expedited discovery, against Health and Human Services (HHS) Secretary, Kathleen […]
The Recovery Audit Contractor (“RAC”) for region D, HealthDataInsights, Inc. recently published its RAC website, and published its first list of approved RAC audit issues for complex coding reviews. Pursuant to the recently-published CMS RAC Review Phase In Strategy, complex reviews regarding DRG validation and coding errors were scheduled to begin in August or September […]
The Recovery Audit Contractor (“RAC”) vendor for Region C, Connolly Consulting (presently acting in South Carolina and Florida), has published its initial approved audit issues. Medicare providers and suppliers in these states can expect RAC auditing to begin soon in following areas, including: • Blood Transfusions • Untimed codes • IV Hydration Therapy • Bronchoscopy […]
Get ready: the Centers for Medicare and Medicaid Services (CMS or Medicare) Recovery Audit Contractor (RAC) program has been made permanent and is expanding nationwide. All Medicare providers and suppliers should begin to prepare now for increased Medicare scrutiny. Hospitals and health systems nationwide can expect RAC auditing activity and overpayment requests beginning in 2009, […]
On May 22, 2009, CMS published changes to the Medicare Benefit Policy Manual and Medicare Claims Processing Manual related to outpatient observation. The changes are set forth in Transmittal 1745 and will become effective July 1, 2009. The changes delete references to “admission” and “observation status” in relation to outpatient observation services. CMS acknowledged that […]
According to its most-recently published “Expansion Schedule,” the Centers for Medicare and Medicaid Services (CMS) planned to expand the Recovery Audit Contractor (RAC) program to 23 states by March 1, 2009, and the remaining states by August 1, 2009 or later. RAC automated reviews soon will begin, but medical necessity reviews have been delayed. On […]
The CFO and treasurer of PRG-Schultz International, Peter Limeri, will resign on May 31. PRG-Schultz is a subcontractor in the Centers for Medicare and Medicaid Services (CMS)’ Recovery Audit Contractor (RAC) program that identifies and corrects past improper payments from healthcare providers. As a subcontractor, PRG-Schultz keeps between 9% and 12.5% of the payments they […]
The Health Care Fraud Prevention and Enforcement Action Team (“HEAT”)’s formation was announced today by US Attorney General Eric Holder and U.S. Secretary of Health and Human Services (“HHS”) Kathleen Sebelius. The purpose of HEAT is to assist in the crackdown on Medicare fraud. HEAT will be comprised of members of both the Department of […]
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