New GAO Report Points to Ongoing Need for Recovery Auditing


September 3, 2013

New GAO Report Points to Ongoing Need for Recovery Auditing

In effort to combat billions in Medicare waste, recovery auditors examine more claims, recover more improper payments and are less burdensome to providers than other contractors

Washington, D.C. – The American Coalition for Healthcare Claims Integrity today reacted to a new Government Accountability Office (GAO) comparison of contractors that conduct post-payment reviews of Medicare fee-for-service claims.  Recovery Auditors (RAs), who act in partnership with the Centers for Medicare & Medicaid Services (CMS), are part of a vital effort to combat billions of dollars in improper payments billed to Medicare each year.

“The report reinforces that recovery auditors remain an effective weapon in the fight against waste in the nation’s healthcare system,” said Coalition spokesperson Becky Reeves.  “According to the GAO, recovery auditors examine more payments, recover more improper payments and are more successful at minimizing provider burdens than any other contractor serving CMS integrity programs.”

Contractors in the Medicare Fee-for-Service Recovery Auditor (RA) program recouped $2.29 billion in improper payments last year and are on track to make significant returns to the Medicare Trust Fund again in 2013.  The program’s success, however, hasn’t stopped the hospital industry from pushing legislation – S. 1012 and H.R. 1250 – designed to make the RA program less effective.

“While the American Hospital Association continues to push Congress for less oversight of provider payments, the GAO says the biggest problem is ‘variance’ among the different audit programs, not the inconvenience claimed by providers,” said Reeves.  “The AHA’s argument against RA contractors is dismantled in this report.”

Other GAO findings, released in a report on Medicare integrity programs, include:

  • Among the four programs reviewed, RAs are subject to the greatest oversight and scrutiny. CMS imposes more limits and requirements on RAs than any other integrity program.  Since the inception of the RA program, CMS has made several modifications to the program based on provider feedback.
  • CMS estimates that $32.4 billion in Medicare payments were improper in fiscal year 2012 alone.
  • RAs conducted almost five times as many reviews – about 1.1 million – as the other three contractors combined.
  • RAs are the only Medicare auditors prohibited from denying claims for minor omissions.
  • Collectively, the four programs review less than 1% of all Medicare claims submitted.

“With more than $30 billion in improper payments in the system, integrity programs should be strengthened,” said Reeves.  “Now is not the time to weaken a program that continues to serve Medicare beneficiaries and taxpayers alike.”

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

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