Recovery Audit Case Study
Recovery Audit Contract
Prior Government Accountability Office work has helped identify problems with Centers for Medicare and Medicaid Service’s actions to address improper payment vulnerabilities, and Department of Health and Human Service states that “prior Office of Inspector General(OIG) work identified problems with CMS’s inability to address referrals of potential fraud” (URL 2011). Hence, Congress created the Recovery Audit Contractor Program that was designed specifically to protect Medicare by detecting improper payments, and referring potential fraud to the Centers for Medicare and Medicaid Services(CMS). Given the critical role of identified improper payments, the effective oversight of RAC performance has been crucial. …show more content…
Mccurdy says according to Centers for Medicare Services, “the Medicare Fee-For-Service Recovery Auditor Program identified and corrected $2.57 billion in improper Medicare payments in FY 2014” (URL, 2015). The lion’s share of this amount $2.39 billion signified overpayments collected, compared to $173.1 million in underpayments reimbursed to providers. In view of all programs costs (other than expenses incurred at the third and fourth levels of appeal), Centers for Medicare Services concluded that the Medicare Fee-for-Service Recovery Audit Program returned more than $1.6 billion to the Medicare Trust …show more content…
Furthermore, as we all work to implement the new requirement and assuring the accuracy of data as well as prevention of the RAC audit, the Centers for Medicare Services can examine the reports and lessons learnt for improvement that could have been made by the RAC program and purse other efforts to reduce and eliminate improper payments. Sometimes change can bring about the growth of a successful empire but, with CMS initiating the RAC program, it won’t be a hundred percent guaranteed that it will be
Prior Government Accountability Office work has helped identify problems with Centers for Medicare and Medicaid Service’s actions to address improper payment vulnerabilities, and Department of Health and Human Service states that “prior Office of Inspector General(OIG) work identified problems with CMS’s inability to address referrals of potential fraud” (URL 2011). Hence, Congress created the Recovery Audit Contractor Program that was designed specifically to protect Medicare by detecting improper payments, and referring potential fraud to the Centers for Medicare and Medicaid Services(CMS). Given the critical role of identified improper payments, the effective oversight of RAC performance has been crucial. …show more content…
Mccurdy says according to Centers for Medicare Services, “the Medicare Fee-For-Service Recovery Auditor Program identified and corrected $2.57 billion in improper Medicare payments in FY 2014” (URL, 2015). The lion’s share of this amount $2.39 billion signified overpayments collected, compared to $173.1 million in underpayments reimbursed to providers. In view of all programs costs (other than expenses incurred at the third and fourth levels of appeal), Centers for Medicare Services concluded that the Medicare Fee-for-Service Recovery Audit Program returned more than $1.6 billion to the Medicare Trust …show more content…
Furthermore, as we all work to implement the new requirement and assuring the accuracy of data as well as prevention of the RAC audit, the Centers for Medicare Services can examine the reports and lessons learnt for improvement that could have been made by the RAC program and purse other efforts to reduce and eliminate improper payments. Sometimes change can bring about the growth of a successful empire but, with CMS initiating the RAC program, it won’t be a hundred percent guaranteed that it will be