GAO: RACs Remain Vital to Medicare Integrity

August 13, 2014

CONTACT: Kristin Walter
(202) 898-0995

GAO: RACs Remain Vital to Medicare Integrity
Report evaluates Medicare integrity programs,
emphasizes RAC program’s transparency and effectiveness

Washington, D.C. – The U.S. Government Accountability Office today released a new report evaluating Medicare post-payment integrity programs, including Recovery Audit Contractors (RACs).

“The report confirms that the RAC program’s high level of transparency and oversight are unique from all other integrity programs,” said Kristin Walter, spokesperson for the American Coalition for Healthcare Claims Integrity (ACHCI). “Our coalition agrees that expanding the safeguards already in place with RACs to the other integrity contractors will help promote accuracy, efficiency and effectiveness across all Medicare oversight programs. The Medicare Trust Fund’s solvency is of the utmost importance.”

To improve Medicare oversight, the GAO recommends CMS streamline the compliance requirements for all integrity programs, better monitor auditing activities across programs to prevent duplicative audits, and conduct regular reviews of its contractors.

Following a Congressional mandate to combat widespread Medicare waste, CMS launched the national RAC program in 2009 to review Medicare claims, identify billing errors and recover misused program funds. In five years, RACs have returned over $8 billion to the Medicare Trust Fund and over $700 million to providers, while reviewing less than 2% of Medicare claims.

The previous RAC contracts ended June 1st, halting all Medicare oversight by the program. Recently, CMS announced it will allow the RAC program to review a limited number of billing issues while awaiting the award of new RAC contracts that would restart the program.

“This report is a call to action for all Medicare stakeholders,” said Walter. “While oversight efforts have been essential to managing Medicare’s fiscal health, refining these programs based on provider and auditor feedback will ensure these initiatives are efficient and effective over the long-term. The recommendations related to better communication and better coordination through the Recovery Audit Warehouse are constructive suggestions and we look forward to working collaboratively with
CMS as it addresses the recommendations.”

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

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