Health Care Providers Brace for Medicare Audits

Introduction

By Sylvia Hsieh

Health care providers are preparing for a national rollout of Medicare audits aimed at recovering money owed to the government due to incorrect billing by providers. The Recovery Audit Contractor (RAC) program began in 2005 as a demonstration project in three states, and then expanded to more states – including Massachusetts – in 2007. It is scheduled for permanent rollout across the country in 2010. RACs are private companies hired by the Centers for Medicare & Medicaid Services to audit health care billing records to identify improper payments. Improper payments can be overpayments or underpayments.

Given the success of the demonstration program – Medicare recovered over $1 billion in overpayments – many health care providers are seeking legal advice on RAC audits and compliance procedures, as well how to appeal RAC claims.

Preparing for a RAC audit should be part of an overall compliance program, according to Vincent L. DiCianni, an attorney who now runs Affiliated Monitors, Inc, a company with offices in Boston and Westborough, Mass., that advises physicians and other practitioners on compliance matters.

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