Coalition of Healthcare Auditors Warns Against Efforts to Undermine Government Accountability Programs


March 12, 2013

Coalition of Healthcare Auditors Warns Against Efforts to Undermine Government Accountability Programs

Highly-effective waste, fraud and abuse prevention programs are at risk; proposed changes could cost Medicare nearly $1 billion each year

Washington, D.C.The American Coalition for Healthcare Claims Integrity (ACHCI) today warned against efforts to restructure several highly effective government accountability and transparency programs that were expanded under the Patient Protection and Affordable Care Act in 2009.

During the 112th Congress, legislation was introduced that threatened several successful healthcare auditing and improper payment measurement programs overseen by the Centers for Medicare and Medicaid Services (CMS). These included the Recovery Audit Contractor (RAC) program and Comprehensive Error Rate Testing (CERT) program. These proven accountability initiatives, targeted last year by H.R. 6575, save Medicare nearly $1 billion each year and bring transparency to government healthcare programs through identification of improper payments.

“Since their inception, these accountability programs have been working to identify billions of dollars of waste and fraud in the nation’s healthcare system,” said coalition spokesperson Becky Reeves. “Our coalition members work independently and at no cost to hospitals to protect Medicare and Medicaid, and identify instances where improper billing or mistakes have occurred.”

CMS estimates that $65 billion in improper Medicare and Medicaid payments are made each year – a growing problem that poses a significant risk to the programs’ long-term viability. In 2012, projected improper Medicare Fee-for-Service payments totaled $29.6 billion, up from $28.8 billion in 2011.

Contractors in the Medicare Fee-for-Service Recovery Audit program recouped $2.29 billion in improper payments last year and are on track to continue to make returns to the trust fund in 2013. This has not stopped efforts to undo provisions in the Patient Protection and Affordable Care Act that have led to record-breaking recoveries of $10.7 billion since 2009, thanks in part to the following programs:

  • Zone Program Integrity Contractors (ZPICs): ZPICs work to identify fraud in Medicare Parts A & B, and coordinate patient coverage between Medicare and Medicaid.
  • Medicare Recovery Audit Contractors (RACs): RACs work to detect and correct improper payments across the Medicare program.
  • Medicaid Integrity Contractors (MICs): MICs work with the Medicaid program to review and audit claims, identify overpayments and educate providers about Medicaid integrity issues.

ACHCI members are urging members of Congress to reject calls for new legislation in the 113th Congress that would dismantle these programs.

“Our coalition members have a proven track record of helping return significant funds to government healthcare programs by identifying waste, fraud and abuse in the system,” said Reeves. “We are asking Congress to think twice before introducing any new legislation that poses a threat to taxpayers, seniors, and accountability in the nation’s healthcare system.”

For more information, please visit: www.properpayments.com.


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