Medicare Integrity Coalition Applauds Chairman Issa For Considering Ways to Strengthen the RAC Program


January 9, 2014

CONTACT:  Kristin Walter
(202) 898-0995

Medicare Integrity Coalition Applauds Chairman Issa For Considering Ways to Strengthen the RAC Program

ACHCI echoes calls to preserve the highly effective RAC program, delivers 2013 ‘to-do list’ to Congress 

Washington, D.C. – Today, Thomas Schatz, president of the Council for Citizens Against Government Waste (CAGW) testified before the House Committee on Oversight and Government Reform, headed by Chairman Darrell Issa (R-CA), on ways to eliminate wasteful government spending. In his comments, Schatz highlighted the Recovery Audit Contractor (RAC) program as a highly effective weapon against government waste and urged committee members to refrain from any further suspensions of the program.

“RACs are responsible for identifying overpayments in Parts A and B and bringing those improper payments to the attention of CMS,” said Schatz. “[…] The program works well and should be continued. Unfortunately, under pressure from providers, CMS has suspended a significant portion of its audits and is considering a change in rules governing some claims. The CMS review process began in the last quarter of 2013 and was extended through March 2014, which means that about $1 billion per quarter will not be recovered by RACs.”

“CAGW’s testimony emphasizes the critical role of Medicare integrity programs in combating wasteful government spending,” said Kristin Walter, spokesperson for the American Coalition for Healthcare Claims Integrity (ACHCI). “The RAC program is the most successful oversight initiative in Medicare history in terms of dollar-for-dollar returns on investment. The program has successfully recovered more than $7 billion in Medicare waste, fraud and abuse since it began in 2009. This is impressive considering that RACs bear all the risk, while being paid on a commission basis only for underpayments and overpayments actually recovered. We commend Chairman Issa and the other members of the committee for devoting time and attention to this important issue.”

In tandem with supporting CAGW’s testimony, members of the Coalition submitted a set of recommendations to Congress aimed at strengthening the RAC program and Medicare integrity initiatives overall. The recommendations include:

  • Get RACs Back To Work. We strongly encourage members of Congress to oppose any effort to weaken or dismantle Medicare waste-prevention programs, such as The Two-Midnight Rule Delay Act of 2013 (H.R. 3698) or in clauses embedded in ‘doc fix’ legislation. Recently, the rule suspended RAC review of short inpatient hospital stays until March 31, 2014. This audit suspension will cost the Medicare Trust Fund more than $2 billion, according to a recent Congressional Budget Office estimate.
  • Ensure Consistency in the Appeals Process. While RAC accuracy scores are extremely high, there is room for improvement in the appeals process. Lawmakers should fix the appeals process to ensure that all levels of appeals follow the same Medicare policies. All levels should be consistent.
  • Consolidate Transparency Requirements For All Medicare Integrity Programs. RACs are subject to greater oversight than any other type of Medicare integrity contractor. Extending the transparency and governance requirements imposed on RACs to all Medicare integrity programs will simplify the auditing experience for providers, helping increase program compliance. In July 2013, the Government Accountability Office reported that the greatest challenge to ensuring Medicare integrity is the variance in requirements imposed by CMS, further highlighting the need for consolidating these rules across all programs.
  • Offer More Education to Providers. Congress should arm providers with increased educational resources, tools and information to help prevent improper payments before they happen. Our coalition welcomes the opportunity to provide feedback, advice or consultation to Medicare administrators or legislators about how to improve the auditing experience for providers.


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

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About the American Coalition for Healthcare Claims Integrity

Founded in 2009, the American Coalition for Healthcare Claims Integrity (ACHCI) is a non-profit organization committed to working toward achieving 100% accuracy in payment claims submitted to public and private sector healthcare payors. The coalition’s mission is to educate policymakers and other stakeholders regarding the importance of healthcare integrity programs that help identify and correct improper payments.  ACHCI’s founding members are partners in critical accountability initiatives including the federal Recovery Audit Contractor (RAC), Zone Program Integrity Contractor (ZPIC), and Medicaid Integrity Contractor (MIC) programs.

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