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CAGW Slams CMS for Gutting Recovery Audits, Costing Taxpayers Up to $4 Billion

Today, Citizens Against Government Waste (CAGW) expressed alarm over the Centers for Medicare and Medicaid Services’ (CMS) January 31, 2014 decision to extend by another six months to the current suspension of recovery audits of medically unnecessary and improper healthcare claims by hospitals.  Under relentless pressure from hospitals, CMS officials instituted a three-month moratorium on oversight by recovery auditing contractors (RACs) starting on October 1, 2013, which was then extended to March 31, 2014. During this time, CMS was supposed to clarify […]

Inside Health Policy: Program Integrity Contractors Ask Lawmakers To Reinstate RAC Audits After CMS Extends Enforcement Delay

  This week, the Proper Payments coalition sent letters to the House and Senate, urging  lawmakers to challenge the Centers for Medicare and Medicare Services (CMS) on its authority to suspend Medicare auditing without congressional approval. The letters were sent in response to CMS’s decision to delay enforcement of the two-midnight rule and to suspend the majority of Medicare audits through Oct. 1, 2014. FROM INSIDE HEALTH POLICY: “The ability of healthcare officials to forgo congressional approval on a decision […]

Coalition Calls on Congress to Examine Suspension of RAC Program, Bolster Medicare Oversight

  FOR IMMEDIATE RELEASE February 3, 2014 Coalition Calls on Congress to Examine Suspension of RAC Program, Bolster Medicare Oversight Year-long moratorium will cost $4 billion; ACHCI proposes alternative solution Washington, D.C. – The American Coalition for Healthcare Claims Integrity today sent a letter to Congress regarding the decision by the Centers for Medicare and Medicaid Services (CMS) to extend the two-midnight rule delay and suspend a large portion of Medicare audits through Sept. 30, 2014.  The letter, which was sent […]

Open Letter to Congress: Examine Suspension of RAC Program

  The American Coalition for Healthcare Claims Integrity today sent the following letter to members of the House Oversight and Government Reform Committee, Senate Homeland Security and Governmental Affairs Committee and Senate Finance Committee. The letter urged lawmakers to investigate CMS’s suspension of the Recovery Audit Contractor (RAC) program, in light of Medicare’s overwhelming volume of waste, fraud and abuse. The decision by CMS conflicts with the agency’s website, which states that RACs are reviewing claims filed up to three years […]

The Fiscal Times: Medicare Execs Are Overpaying $35 Billion a Year…And They Don’t Seem to Care

  Despite highly effective efforts like the Recovery Audit Contractor (RAC) Program to weed out waste in Medicare, the marquee healthcare program continues to lose billions to improper payments. Analysis from The Fiscal Times shows strengthening the RAC program and other integrity initiatives would save enough money to cover numerous major federal expenditures. FROM THE FISCAL TIMES: Medicare’s Private Fee-For-Service Plans, just one of the many entitlement programs run by the Centers for Medicare and Medicaid Services, overpaid billers by $34.6 […]

New York Times: Doctors Abusing Medicare Face Fines and Expulsion

  The Centers for Medicare and Medicaid Services has announced it will impose fines on doctors who abuse Medicare funds in an effort to decrease improper payments. Despite education to combat misuse of program funds, a group of repeat offenders continues to drain the Medicare Trust Fund through rampant waste, fraud and abuse. FROM THE NEW YORK TIMES: The Obama administration is cracking down on doctors who repeatedly overcharge Medicare patients, and for the first time in more than 30 years the […]

New York Times: Hospital Chain Said to Scheme to Inflate Bills

  This week, the Justice Department is taking action against Health Management Associates – one of the largest hospital systems in the U.S., operating 71 hospitals in 15  states – for intentionally over-admitting patients and penalizing physicians who failed or refused to partake in  the scheme. Federal officials intervened after whistleblowers filed eight respective false claims lawsuits against the hospital system. FROM THE NEW YORK TIMES: Every day the scorecards went up, where they could be seen by all of […]

Inside CMS: Medicare Auditors Blast ALJ Suspension Of New Appeals, Seek Reform

  In letters sent to members of Congress this week, the Proper Payments coalition urges lawmakers to impose explicit Medicare compliance requirements on administrative law judges, who review Recovery Audit Contractor decisions at the third level of appeal. FROM INSIDE CMS: Medicare program integrity contractors are adding their voices to the push for Medicare appeals process reforms, particularly at the third level of the appeals system where a backlog has caused a wait of at least two years before new […]

Medicare Recovery Audit Contractors Ask Congress for Changes

  Today, the Proper Payments coalition sent letters to the House and Senate, urging lawmakers to oppose ongoing threats to the Recovery Audit Contractor (RAC) program, including recent changes to the RAC appeals process. FROM HEALTH DATA MANAGEMENT: While the American Hospital Association recently accused Medicare officials of breaking the law by suspending appeals of Recovery Audit Contractor decisions to administrative law judges for two years to reduce a huge backlog, an association representing contractors has a different perspective. The American Coalition […]

Coalition to HHS: Fix the RAC Appeals Process

  FOR IMMEDIATE RELEASE January 21, 2014 Coalition to HHS: Fix the RAC Appeals Process ACHCI urges Congress to reform the RAC appeals process, preserve Medicare’s top integrity program Washington, D.C. – The American Coalition for Healthcare Claims Integrity today submitted the following statement regarding the decision by the Department of Health and Human Services (HHS) to no longer accept certain appeals of Recovery Audit Contractor (RAC) Program decisions. Citing a backlog of 357,000 existing cases, HHS said it will […]