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Category : Press Release

RACFacts: How do RACs review claims?

How do RACs review claims? Have you ever wondered how Recovery Auditors look at Medicare claims? How do they decide what issues to review, and who actually participates in the review process? Recovery Auditors employ numerous staff from the medical field to assess claims – Medical Directors, Nurses, Coders and countless healthcare reimbursement experts. All three types of review outlined below are overseen by the auditor’s Medical Director. Following is a diagram that walks through the process that takes place […]

May Reports: Two Missouri Hospitals Overbilled Medicare $900k

FOR IMMEDIATE RELEASE                                                 CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995 May Reports: Two Missouri Hospitals Overbilled Medicare $900k Washington, D.C. – Two reports released in May 2015 by the Office of Inspector General found that Missouri hospitals overbilled Medicare $900,000. According to the OIG, Saint Luke’s Hospital of Kansas City improperly billed Medicare in 27 percent of claims, resulting in overpayments […]

RACFacts: Do You Know What RACs Can Audit?

Do You Know What RACs Can Audit? Recovery Audit Contractors (RACs) have returned nearly $10 billion in mis-billed taxpayer dollars to the Medicare Trust Fund over the past five years while reviewing less than 2 percent of Medicare claims. Despite this success, the waste-busting RAC program is essentially sidelined. Recently, the moratorium on RAC reviews of hospital short stays was extended again until October 2015. This two-year moratorium prevents auditors from looking at the number one area for mis-billed Medicare […]

Virginia Hospitals Overbilled Medicare $100 Million

FOR IMMEDIATE RELEASE                                                 CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995  Virginia Hospitals Overbilled Medicare $100 Million Washington, D.C. – Virginia ranks number 11 on a list of worst states for Medicare waste, overbilling Medicare $100 million in 2013, according to the most recent annual report by the Center for Medicare and Medicaid Services (CMS). Improper Medicare billing among […]

Kentucky Hospitals Overbilled Medicare $52 Million

FOR IMMEDIATE RELEASE                                  CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995 Kentucky Hospitals Overbilled Medicare $52 Million Washington, D.C. – Washington state ranks number 22 on a list of worst states for Medicare waste, overbilling Medicare $52 million in 2013, according to the most recent annual report by the Center for Medicare and Medicaid Services (CMS). Improper Medicare billing among the state’s healthcare providers increased $33 […]

RACFacts: Top 10 Things Hospitals Don’t Want You To Know About Recovery Auditing

Top 10 Things Hospitals Don’t Want You To Know About Recovery Auditing The Medicare Fee-For-Service error rate has jumped to the highest level in history, 12.7%, which equates to an annual loss to the program of $46 billion. Since 2005, the hospital industry and their representatives in Washington have been aggressively fighting to keep improperly billed funds – spending $20 million to lobby Congress in 2014 alone (1) – and attack Medicare integrity programs, like the Recovery Audit Contractor (RAC) […]

Washington Hospitals Overbilled Medicare $50 Million

FOR IMMEDIATE RELEASE                        CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995  Washington Hospitals Overbilled Medicare $50 Million Washington, D.C. – Washington state ranks number 24 on a list of worst states for Medicare waste, overbilling Medicare $50 million in 2013, according to the most recent annual report by the Center for Medicare and Medicaid Services (CMS). Improper Medicare billing among the state’s healthcare providers increased $11 million over the previous year. “With waste on the rise, it is vital to have policies […]

RACFacts: Pay-For Performance Contracts Save Taxpayers Money

Pay-For Performance Contracts Save Taxpayers Money Performance-based payments are a financial best practice and the standard in the recovery auditing industry. The client wins when no upfront expenses occur and payments are made only when actual dollars are returned. In the case of vital Medicare oversight programs, the client is the Federal government. Recovery Auditors, who work to return Medicare payments to the Trust Fund, are compensated using this pay-for-performance model. They are paid a small percentage of what they […]

Top 10 States For Medicare Waste Overbilled $2 Billion

FOR IMMEDIATE RELEASE                                                CONTACT: Kristin Walter kristin.walter@rubinmeyer.com (202) 898-0995  Top 10 States For Medicare Waste Overbilled $2 Billion Council for Medicare Integrity releases annual list of most wasteful states Washington, D.C. – The Council for Medicare Integrity (CMI) today released its list of the Top 10 States for Medicare Waste, compiled using data from the Center for Medicare and Medicaid Services (CMS) FY2013 RAC Report to Congress. California tops the list with $517 million in overpayments from Medicare, improperly billing $150 […]

RACFacts: Obvious Medicare Improper Payments Go Undetected

Obvious Medicare Improper Payments Go Undetected There is a lot of talk lately of “improper payments,” especially when it comes to Medicare. Earlier this month, the GAO released a report stating Medicare has the highest rate of improper payments government-wide, with overbillings of nearly $60 billion in 2014. Of that total, $46 billion was lost specifically from the Medicare Fee-For-Service program. This ultimately means Medicare paid out $60 billion for claims billed improperly in violation of Medicare policy. Although the Recovery […]