The Hill: Feud between hospitals, Medicare contractors explodes over fraud bill


Recovery audit contractors are pushing back on new legislation that weakens oversight of Medicare payments.


RACs charge that the new bill from Reps. Sam Graves (R-Mo.) and Adam Schiff (D-Calif.) will severely undercut their efforts to secure Medicare’s finances at a time when improper payments are rife within the program.

A spokeswoman for the American Coalition for Healthcare Claims Integrity, a nonprofit coalition, pointed to more than $2 billion recovered for Medicare by RACs in 2012.

“The bottom line is that recovery auditors bring accountability and transparency to the Medicare program,” said Amanda Keating. “If you want to send Medicare crashing to the ground, letting improper payments run rampant is a surefire way to do that.”


RACs have garnered praise for their success in restoring money to Medicare’s trust fund. But hospitals have also quarreled with how contractors pursue potentially bad claims.

A longtime area of conflict is how many RAC audits are overturned on appeal.

Surveys from the American Hospital Association have found that more than 70 percent of RAC audits are later reversed.

But the Centers for Medicare and Medicaid Services (CMS) said last year that only about 2.4 percent of all 2010 claims collected were both challenged and overturned.

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