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RAC Oversight Lacking, OIG Charges

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

To remedy these and other issues, the OIG made these recommendations:

  • Assess the vulnerabilities pending corrective action and develop timeframes for addressing them to make sure they are resolved in a timely manner.
  • Improve education to ensure that RACs refer all appropriate cases of potential fraud by providing specific examples of fraud that should be referred and regularly communicating with RACs to share information about fraudulent coding or billing schemes.
  • Take appropriate and timely action on RAC referrals of potential fraud.
  • Develop evaluation metrics to improve RAC performance and to ensure that RACs are evaluated on contract requirements. "Metrics should include accuracy targets for RAC determinations of improper payments or similar measures (e.g., effectiveness ratings)," says the report.

In a written response included in the OIG report, Marilyn Tavenner, the CMS administrator, concurred with items 1, 2, and 4. Regarding item 3, Tavenner provided an update on CMS action taken on six cases in question but did not make any future commitment.

Margaret Dick Tocknell is a reporter/editor with HealthLeaders Media.
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