• E-mail
• Print
• RSS
• Buy It Now
• Reprints

New auditors contracted by CMS will get a percentage of findings

Health Care Auditing Strategies, May 1, 2005

This is an excerpt from a member only article. To read the article in its entirety, please login.

CMS promises strong oversight of auditors' discoveries

Scrutinizing thousands of Medicare claims forms would be a daunting task. However, receiving a cut of any overpayment findings would likely sweeten the challenge.

This month, contracted auditors in Florida, New York, and California will begin reviewing thousands of year-old Medicare claims forms filed by healthcare providers in their states. Unlike other contracted Medicare claims checkers, they will receive a percentage of the overpayments they discover.

CMS has hired recovery audit contractors (RAC) as part of a three-year pilot program/demonstration aimed at adding more scrutiny to the Medicare claims process. The program also charges investigators with finding underpayments, but it will not offer the same financial incentive for those findings. The percent of overpayment findings each auditor receives varies by contract.

Critics say the carrot aspect of the RAC program doesn't sit well.

"I think it's a matter of concern because there is an incentive for the auditors to find problems and there may be a tendency to overreach a bit," says Susan V. Kayser, Esq., a partner at Duane Morris, LLP, of New York City.

This is an excerpt from a member only article. To read the article in its entirety, please login.

• E-mail to a Colleague
• Print
• RSS
• Archive
• Buy It Now
• Reprints / Permissions