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RAC Oversight Lacking, OIG Charges

Margaret Dick Tocknell, for HealthLeaders Media, September 5, 2013

More than half of those payments involved billing code errors and care delivered in settings that were too intensive or expensive. About $903 million in improper payments were recovered from or returned to providers.

CMS identified some 46 vulnerabilities—including suppliers and providers billing separately for bundled services—that led to improper payments. While specific corrective actions were taken to remedy the issues, CMS never evaluated the effectiveness of those actions. "As a result, high amounts of improper payments may continue," according to the report.

The report notes that the Government Accounting Office identified similar vulnerabilities in a 2010 report.

While RACs focus on identifying payment errors, they are also required to report evidence of potential fraud. For FY 2010 and FY 2011 the RACs reported only six cases nationwide on the basis of "external notification," which typically means complaints from provider employees who were asked to submit false claims. The report notes that in November 2012, CMS still had not taken any action on the cases.

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