Medicare RAC Overpayment Collections Hit $4.5B Since 2009

Since the Medicare Recovery Auditor, or RAC, program began in October 2009, hospitals and providers have had $4.5 billion in Medicare overpayment recouped, according to the latest RAC figures from CMS.

In the first six months of the federal government's 2013 fiscal year, Medicare RACs have recouped $1.37 billion and have returned $65.4 million in underpayments. CMS did not identify how much of those recoupments were tied up in the appeals process or had been successfully appealed by providers.

In the second quarter, Medicare RACs collected $626.5 million in overpayments — almost equaling what was recouped in fiscal year 2011 alone. Medicare RACs returned $31 million in Medicare underpayments.

Medical necessity of cardiovascular procedures continued to be the top overpayment issue for RACs. Minor surgery and other treatments billed as inpatient when they should have been billed as outpatient or observation was another top recoupment reason. CMS again did not disclose the most common issues for underpayments.

HealthData Insights and Connolly collected roughly $400 million of all Medicare overpayments in the second quarter ended March 31. HDI and Connolly audit hospitals in 32 states across the West and South, including Florida, Texas and California.

More Articles on Medicare RACs:

CMS Adjusts Medicare RAC Documentation Limits
Medicare RACs, Hospitals Spar Over New Fraud Legislation
House Reintroduces Bill to Reform Medicare RACs

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