GAO criticizes Medicare Part D recovery audits

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The Medicare Part D recovery audit contractor program has shown limited results and needs improvement, according to a new report from the U.S. Government Accountability Office.

The Medicare Part D RAC recovered less than $10 million in improper payments from January 2011 to May 2015, according to the GAO. That relatively small amount could be due to difficulties between the RAC and the Centers for Medicare & Medicaid Services in deciding which issues warranted an audit. CMS approved just one of the 15 audit proposals from the RAC since 2011, the report found.

CMS hasn't done an annual evaluation on the Part D RAC since it was first implemented, the GAO asserted, although one for the 2014 year is pending.

The Medicare Part D RAC is ACLR Strategic Business Solutions based in Livonia, MI. ACLR's contract is set to expire Dec. 31, according to Bloomberg BNA.

As CMS begins to solicit the next RAC contracts, it should set clearer expectations in contract work statements, conduct annual RAC performance evaluations and review the process for approving audit proposals, GAO recommended.