Medicare RACs Nab $2.2B in Overpayments in Past 9 Months

In the first nine months of the 2013 federal fiscal year, ended June 30, Medicare recovery auditors recouped approximately $2.24 billion in overpayments from hospitals and other providers, according to the latest figures from CMS.

Government data also showed providers received $101.9 million back from recovery auditors, better known as RACs, so far in FY 2013.

Since the program started in October 2009, Medicare RACs have collected more than $5.4 billion in overpayments and returned $370.1 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 third quarter alone, Medicare RACs recovered $855.3 million, while returning only $36.3 million in underpayments. This means for every dollar a Medicare RAC returned to a provider for an underpayment, it collected $23.56 in overpayments. HealthData Insights and Connolly continue to be the most active RACs, as they each collected roughly $289 million in overpayments in the third quarter. HDI and Connolly audit hospitals in 32 states across the West and South, including Florida, Texas and California.

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 the other top overpayment reason. CMS did not disclose the most common issues for underpayments.

More Articles on Medicare RACs:
OIG: Despite Flaws, Medicare RACs Work
AHA: Medicare RAC Requests Up 47% Over the Past 6 Months
AHA, 4 Health Systems Lobby Congress for RAC Changes

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