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


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 to members of the House Oversight and Government Reform Committee, Senate Homeland Security and Governmental Affairs Committee and Senate Finance Committee, 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 grave implications of this decision cannot be overstated,” the letter said. “For five years, recovery auditors have worked on behalf of taxpayers to weed out waste in Medicare, returning more than $7 billion to the Medicare Trust Fund. In fact, RACs only audit two percent of all Medicare billings, and yet find errors in nearly 50 percent of those records. This additional delay will halt auditing for an entire year, cost the Medicare Trust Fund more than $4 billion in unrecovered funds, threaten Medicare’s long-term solvency and weaken healthcare coverage for the nearly 50 million seniors who rely on this program every day.”

The letter goes on to question how a successful Medicare oversight program can be suspended for a full year without congressional approval. As a result, the coalition poses an alternative solution to CMS’s current decision to cripple Medicare integrity programs.

“To protect Medicare and give hospitals time to transition to the two-midnight rule, we recommend that auditing be reinstated immediately according to the following guidelines:

  • For Medicare admissions prior to Oct. 1, 2013, RACs will audit according to the old rule, in effect at the time of service.
  • For Medicare admissions between Oct. 1, 2013 and Sept. 30, 2014, RACs will audit according to the old and new two-midnight rule, applying the rule that favors the hospital while still identifying improper payments for the Trust Fund.
  • For Medicare admissions after Oct. 1, 2014, RACs will audit according to the new rule.

This approach would benefit everyone by providing hospitals ample time to educate staff on the rule change, returning $1 billion per quarter back to the Medicare Trust Fund, strengthening coverage for Medicare beneficiaries, and saving billions for American taxpayers.”

Read the full text of the letters sent to members of the House and Senate. For more information, please visit: www.properpayments.com

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