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Recovery Audit Program Extended to Medicaid

White House pushes to further curb waste, fraud and abuse…

 Last week the Department of Health and Human Services (HHS) released its final rule establishing the Medicaid Recovery Audit program.  The Centers for Medicare and Medicaid Services (CMS) touted the program as a key part of the Obama Administration’s initiatives to curb waste, fraud and abuse within the Medicaid system, and extending the Recovery Audit initiatives beyond Medicare for the first time.

Affordable Care Act Expands

Once again, we see the “Obamacare” Act, formally the Affordable Care Act, further taking shape and reaching out to touch yet another entitlement program.  The program was introduced by CMS and places even more powers in the hands of Recovery Audit Contractors (RAC’s) by giving them the ability to detect and correct past improper payments, and review claims after Medicaid payments have been made.  Automated and detailed review protocols will be implemented that include medical records reviews of all types, including ambulance.  RAC’s will be given the ability to review claims dating back three years from the date the claim was paid and they will be charged with identifying and recovering over and under (more over than under we’re sure) payments to providers in the Medicaid system.

The Cost- $350 Million Over 10 Years!

“The Affordable Care Act provides an additional $350 million over the next 10 years and an annual inflation adjustment to ramp up anti-fraud efforts, including increasing scrutiny of claims before they’ve been paid, investments in sophisticated data analytics and more ‘feet on the street’ law enforcement agents and others to fight fraud in the health care system,” says CMS in a recent Fee-For-Service listserv e-mail.  However with projected savings estimated to possibly hit the $2 billion mark, the Administration is betting that the system will more than recover those fees over time.

The e-mail announcement explains that CMS intends to use similar technology used by credit card companies to stop fraud. 

Guaranteed cash flow during transition.