Bipartisan Legislation to Improve Medicare Audit System Introduced in U.S. House of Representatives


On March 19, 2013, Congressmen Sam Graves (R-MO) and Adam Schiff (D-CA) reintroduced the Medicare Audit Improvement Act (MAIA or Act), which could improve some aspects of the Medicare audit system.  The proposed legislation—which was originally introduced in 2012 but died in committee—would amend the Medicare Modernization Act of 2003 to address problems with the Recovery Audit Contractor (RAC) program created by that law. 

Among other things, the MAIA seeks to ease the burden imposed on providers by the often onerous Medicare audit system and reduce the incentives of the Medicare contractors to unnecessarily overturn initial claims determinations.  For example, the Act would place a cap on the number of Additional Document Requests Medicare auditors are permitted to make, impose financial penalties on Medicare contractors when a denial is overturned on appeal, and limit certain medical necessity audits to scenarios involving “widespread payment error rates.”   

We will continue to monitor the progress of the MAIA in Congress and other legislative movement with respect to the Medicare audit system.

A copy of the Act is available by clicking here.

Reporter, Sara Kay Wheeler, Atlanta, GA, +1 404 572 4685,

DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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