Medicare RACs corrected $92 million worth of payments in 2010

Auditors corrected about $75 million in Medicare overpayments and almost $17 million in underpayments in the Centers for Medicare & Medicaid Services’ (CMS) first report to Congress on the National Recovery Audit program.

The $92.3 million in corrected overpayments and underpayments for fiscal year 2010 came from four regions (see image below) by four recovery auditors: $5.9 million from Diversified Collection Services in Region A; $15.5 million from CGI, Inc., in region B; $27.5 million from Connolly, Inc., in region C; and $43.4 million from HealthData Insights in region D.

“There are multiple circumstances that can result in improper payments, including payment for items or services that do not meet Medicare‘s coverage and medical necessity criteria, payment for items that are incorrectly coded, and payment for services where the supporting documentation submitted did not support the ordered service,” CMS wrote in its report.

The original recovery audit demonstration was conducted from March 2005 to March 2008, in six states, to determine if recovery auditors could identify improper payments for claims paid under Medicare Part A and Part B. Based on the demonstration’s success, Congress passed the Tax Relief and Health Care Act of 2006, which authorized the expansion of the Recovery Audit program nationwide by January 2010.

Topics: Articles