Have you heard the news? CMS has started to expand its recovery program to include Medicaid as well as seeking out overpayments in Medicare private plans and the program's drug benefit. CMS wants this to happen by the end of the year.
Why the aggressive push? Simple, RAC auditors have identified around $1 billion (yes, that’s billion with a b” in Medicare overpayments over a three year period from the original pilot program launched in California, New York & Florida.
Sounds great that the government is working hard to recoup hard earned dollars that were wrongfully spent, and putting them to better use within our healthcare system. However, if we dig a little deeper what do we find? For starters, auditors are paid based on the dollar amount of improper payments they find which makes these contractors suspect given the self-serving nature of this set up.
More importantly, it is incredibly burdensome for physicians to comply with the audits even when the reviews turn up little or no evidence of Medicare overpayments. There are a number of credible reports from physicians who were audited during the pilot project where it appeared that the auditors were simply on fishing expeditions to find overpayments, and demanding numerous medical records from years gone by.
While no-one doubts there is fraud and abuse in Medicare does adding such burdensome regulations to physicians who are already the most regulated of all businesses really accomplish anything?
Given that these contractors are being paid handsomely and that they are highly incentivized to dig as deep as they can to see what they can find, who is really benefiting here? CMS or these outside independent auditing companies?
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