Improper payments totaled over a billion dollars in 2010 and 2011.
The recovery audit contractors (RACs) mean business and the Office of the Inspector General (OIG) is taking a serious view of preventive actions required. The Centers for Medicare & Medicaid Services (CMS) released a report in late 2013 Actions to Address Improper Payments, Referrals of Potential Fraud, and Performance, on actions taken based on previous RAC audits.
Background: In fiscal years 2010 and 2011, the RACs identified half of all claims that they reviewed as involving improper payments, which totaled $1.3 billion.
Although CMS took corrective actions to address most vulnerabilities it found during those years, the agency “did not evaluate the effectiveness of these actions,” the OIG says in its report. “Additionally, CMS did not take action to address the six referrals of potential fraud that it received from RACs,” the report notes.
How this impacts you: The OIG has asked CMS to start closing in on vulnerabilities and take immediate action on potential fraud. Therefore, if your MAC was sitting on its hands following RAC recommendations, it could be coming down on your coding and billing habits soon, so make sure you are filing claims properly. To help you pinpoint the most common vulnerabilities as well as tips for dealing with RACs, we’ve broken down the RAC findings below:
To read the complete OIG report on RACs, visit oig.hhs.gov.