Updated on: November 29, -0001

RACs Resorting to Tabloid Tactics to Gain Favor

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Original story posted on: March 4, 2015

In today’s world of 140-character tweets and instant access to information on a 4-inch screen in your hand, there is great temptation to make use of catchy headlines to get a reader’s attention and influence his or her way of thinking.

While this works when selling a magazine at the checkout counter of the grocery store or getting page views for your website, it would stand to reason that such tactics should not extend to a government contractor. Yet that is exactly what the American Coalition for Healthcare Claims Integrity (ACHCI), the lobbying arm of the Recovery Auditors (RACs), Zone Program Integrity Contractors (ZPICs), and Medicaid Integrity Contractors (MICs) is doing. 

On Feb. 13, ProperPayments, the Twitter handle for the ACHCI, tweeted “another hospital balks at Medicare oversight, trying to strong-arm the OIG. #Medicare http://goo.gl/0kmuCd.” While this might sound like an extortion scheme that warrants FBI intervention, the link takes you to an article reporting that the University of North Carolina disagreed with the findings of its Office of Inspector General (OIG) audit and plans to appeal both the findings and the use of extrapolation. So in the eyes of the RACs, availing one’s legal appeal rights is “strong-arming.”

In its next tweet, on Feb. 17, ProperPayments noted that “the ... hospital lobbying effort has been devastating ... (and that the) improper payment rate in #Medicare ... rose … to $46B in 2014. http://goo.gl/Kfl0mz.” This refers to a report from the website Daily Surge, published by Jason Materra, the author of “Crapitalism: Liberals Who Make Millions Swiping Your Tax Dollars.” That report was written by “Cloakroom Confidential,” a self-described “embedded congressional insider reporting from an office inside the Capitol.” Throughout this article, the author continues to perpetuate the myth that improper payments are equivalent to fraud, blaming hospitals for “abusing the taxpayer.”

Two days later, the same organization tweeted that “Recovery Auditors Blame 'Frequent Filers' For ALJ Backlog Via @MichelleMStein: http://goo.gl/T2iTjj  #Medicare.” The link here takes you to the Inside Health Policy Web page, edited by Michelle Stein, where one is teased with the start of an article noting that “Recovery Auditors are again alleging that hospital ‘frequent filers’ are the cause of the backlog at the third level of the appeals system, and point to a coalition analysis that found only a small percentage of RAC denials were appealed to the administrative law judges in recent years.”

So, who are these “frequent fliers?” No, not the few that utilize more resources than others; to the RACs, every hospital that has ever appealed a RAC denial is apparently considered a “frequent flier.” And once again the RACs are contorting the data on denials and appeals, using all denials issued since the start of the program, including all automated denials, to claim that only 10 percent of all denials were appealed to the administrative law judge. I don’t think that any statistician would consider a 10 percent denial rate to be “small,” and that rate would certainly be much higher if they considered only complex reviews related to admission level of care, which constitute the bulk of ALJ appeals by hospitals.

It is understandable that with the recent proposals to revamp the Medicare short-stay payment policies, which would take away the RACs’ lucrative short-stay admission denial business, that the contractors would push back. But to use inflammatory terms like “strong-arm” and “frequent fliers,” and citing partisan websites that distort facts and exist to divide the country, seems to be below even the standards of the RACs.

The opinions expressed in this article are the author's own and do not necessarily reflect the view of Accretive Health.

About the Author

Ronald Hirsch, MD, FACP, CHCQM is vice president of the Regulations and Education Group at Accretive Physician Advisory Services at Accretive Health. Dr. Hirsch’s career in medicine includes many clinical leadership roles at healthcare organizations ranging from acute care hospitals and home health agencies to long-term care facilities and group medical practices. In addition to serving as a medical director of case management and medical necessity reviewer throughout his career, Dr. Hirsch has delivered numerous peer lectures on case management best practices and is a published author on the topic. He is a member of the American Case Management Association and a Fellow of the American College of Physicians.

Contact the Author

RHirsch@accretivehealth.com

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