Report to Congress finds $474M in improper payments from fee-for-service Medicare
A tweak to the federal government’s methods of auditing healthcare payment programs has scaled back the number of discovered improper payments.
That’s according to the latest report to Congress on 2016 work done by Recovery Audit Contractors in fee-for-service Medicare. The RAC program was put in place to review provider payments, after they’ve been issued, to root out improper payments.
The report noted that in fiscal 2016, RACs found improper payments in a little more than 380,000 claims, representing almost $474 million. That’s a roughly 7.5% increase from the $441 million in improper payments found the previous year. All told, RACs returned a net of $214 million back to the Medicare Trust Fund, a 50% increase over the previous year.
As a way of reducing regulatory burdens on nursing homes and other providers, the government imposed additional document request (ADR) limitations on the number of records RACs can request in a 45-day timeframe. Providers have favored those changes, but at least one advocacy group worries they are limiting recovery of Medicare funds.
The Council for Medicare Integrity said in statement Wednesday that ADR limits have “significantly scaled back RAC audits,” allowing only for about 0.5% of a specific subset of Medicare claims to be reviewed for billing accuracy.