Providers struggle with the demands of the Medicare
audit program and question the fairness of it all.
By Joseph Goedert
The Centersfor Medicareand Medicaid Services in late 2010launcheditsnationwide Medicare Recovery Audit Contractors program, employing outside RAC firms to conduct regular
reviews of billings from hospitals—and to a
lesser extent physician practices—to identify
and recoup overpayments for services rendered to Medicare patients as well as identify
and correct underpayments.
By January 2012, the program had recouped Medicare payments totaling $3.1
billion, according to CMS.
The program relies on regional contrac-
tors that receive a cut of the overpayments
they identify and recoup. Those contractors
can send requests every 45 days for addi-
tional documentation to support the claims
submitted by providers being audited.