As Medicare Auditors Seek to Rein in Costs, Hospital Admission Decisions Are Under Microscope

Recovery Audit Contractors (RAC) out to identify improper payments made on claims for Medicare beneficiaries

The government has made extensive efforts to combat fraud in the Medicare and Medicaid programs, recovering a record $4.2 billion in fiscal 2012 from individuals and companies trying to cheat the system. One of the largest sources of recovered monies is the Recovery Audit Contractor (RAC) program.

The RAC program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare payments to health-care providers under fee-for-service (FFS) Medicare plans. The goal of the RAC program is to identify improper payments made on claims of health-care services provided to Medicare beneficiaries. Improper payments could be overpayments or underpayments. Hospitals have been hit by the audits, with recoveries reaching $3.6 billion since the national program launched in 2010, according to Centers for Medicare & Medicaid Services (CMS) data.1 About $895 million was reclaimed from just six states during the RAC Demonstration Project between 2005 and 2008.

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Source:The Hospitalist