February 12, 2013

RACs Returned $488.2 Million to Medicare in FY2011

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Recovery auditors (RACs) corrected more than 887,000 claims in fiscal year 2011 that accounted for $939.3 million in improper payments, according to a recent report to Congress for that year.

The report notes that the improper payments include $797.4 million in overpayments and $141.9 in underpayments but that because of fees, costs and appeals, the RACs returned $488.2 million to the Medicare Trust Fund.

Some interesting points from the report for fiscal year 2011:

  • RACs received $81.9 million in contingency fee payments.
  • For the first time in FY2011, RACs examined short-stay inpatient hospital admissions, which accounted for a “large portion” of the year’s overpayment collections.
  • RACs has a cumulative accuracy score of 90 percent or higher, according to CMS’ validation contractor.
  • Just 6.7 percent of claims with overpayment determinations were appealed by Medicare providers. But 43.6 percent were overturned on appeal.

To read the full report, visit http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Recovery-Audit-Program/Downloads/FY2011-Report-To-Congress.pdf.

For the issues RACs posted in the past week, see the chart below.

DOWNLOAD RAC ISSUES

About the Author

Karen Long is the editor of Physician Solutions for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

Contact the Author

KLong@decisionhealth.com

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Karen Long

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