Review RAC Demo Project Issues to Understand, Avoid Fraud

Follow up

CMS stated that it researched the cases and determined that they should be referred to the OIG for further development. Up until now, providers have not seen any issues referred to the OIG by the RACs, so this should get everyone's attention, according to Debbie Mackaman, RHIA, CHCO, regulatory specialist for HCPro, Inc.

"Providers shouldn't discount this news just because it is coming from the demonstration project. It would be a good idea for providers to review the demonstration project issues, since we do not know what cases CMS recommended for referral to the OIG," says Mackaman.

"The bottom line is that that RACs are out there to make money based on their findings and contingency fees," says Mackaman. "And since they are obligated to report any suspected fraud to CMS, they are, in a sense, doing a pre-cursory review for the OIG."

CMS stated that it's in the process of developing a tracking system for RAC claims review. In the meantime, however, providers should not only review their own RAC's issues, but also be aware of the issues listed by the other three RACs.

"This is a way to organize your internal audits, make corrections where appropriate, and stay one step ahead of what might be coming," says Mackaman. Overall, it would be labor-intensive and costly to monitor all RAC issues lists; however, in the long run, it could pay for itself.

CMS has already provided two training sessions to RACs, and is in discussion with the OIG and the Department of Justice for additional training.

Anticipation of potential problem areas is essential for providers. After that, maintaining awareness of ongoing RAC activity should help a facility avoid any RAC-related fraud possibilities, according to Mackaman.

James Carroll is associate editor for the HCPro Revenue Cycle Institute.