RAC audits often inaccurate, group claims

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A major hospital group has called for a federal investigation into mistakes made by recovery audit contractors. “Numerous inaccuracies” often result in improperly denied payments and decisions that go unpenalized, laments a letter sent by an American Hospital Association leader. 

Long-term care professionals also are frequent critics of RACs. The contractors are charged with identifying improperly made payments. Such findings can fuel fraud and other law enforcement investigations.

The AHA said it does not object to auditors identifying billing mistakes. Rather it has problems with the deluge of redundant audits and record requests, and the inaccuracy in determining whether providers received overpayments. The special auditors are “often wrong but not penalized for their numerous inaccuracies,” AHA Executive Vice President Rick Pollack wrote in a letter to Department of Health and Human Services Inspector General Daniel Levinson. Moreover, three in four RAC decisions are eventually reversed on appeal, according to the hospital group.

Pollack called for an immediate end to improper Medicare payment denials.