News & Analysis as of

OMHA's Medicare Appellant Forum Offers Few Meaningful Answers for Frustrated Medicare Providers and Suppliers

On February 12, 2014, the Office of Medicare Hearings and Appeals ("OMHA") hosted a Medicare Appellant Forum ("Forum") to address its current backlog of appeals. OMHA is responsible for hearings before Administrative Law...more

More Than 100 House Members Urge HHS to Reform RACs

A bipartisan group of 111 members of the United States House of Representatives sent a letter to HHS Secretary Kathleen Sebelius on February 10, 2014, urging the Secretary to reform the Medicare Recovery Audit Contractor...more

Streamlined RAC Appeal Processes Lead To Winning Legal And Economic Outcomes

Armed with the Recovery Audit Contract (RAC) Program, the Federal government has been very successful in recouping Medicare overpayments from health care providers in recent years. During a RAC audit, program contractors...more

OIG Releases Study on Medicare RAC Performance, Says Contractors Recovered $1.3 Billion in FYs 2010 and 2011

OIG recently published a study analyzing the performance of Medicare Parts A and B Recovery Audit Contractors (RACs) in fiscal years (FYs) 2010 and 2011. OIG said that it conducted the study to evaluate CMS’s oversight of...more

United States Senate Committee on Finance Holds Hearing Regarding Oversight of Recovery Audit Contractors

On June 25, the Senate Finance Committee held a hearing to address the Medicare Recovery Audit Contractor (RAC) Program. Committee members expressed concern that the RAC program creates unreasonable administrative burdens...more

PRIME Act: New Legislation to Curb Health Care Fraud

The United States Senate and House of Representatives recently introduced bipartisan legislation designed to reduce fraud, waste, and abuse in the Medicare and Medicaid programs. The legislation, entitled “Preventing and...more

Recent Changes Impact Appeal of Medicare Denials and Reimbursement Strategies

Recovery Audit Contractors (“RACs”) and other Centers for Medicare and Medicaid Services (CMS) contractors are charged with identifying overpayments made by Medicare to healthcare providers. However, with the increase in RAC...more

Annual Report Shows Meteoric Rise in RAC Activity

On February 5, 2013, CMS issued its mandatory Recovery Audit Contractor (RAC or Recovery Auditor) program annual report, detailing overpayments, underpayments, RAC performance and savings to the Medicare program. According to...more

Dealing with RAC Audits and Denials: How Healthcare Providers Can Manage Medicare Recovery Efforts

Executive Summary: Medicare RAC (Recovery Audit Contractor) audits are becoming increasingly aggressive, creating delays in payment for healthcare providers. Certain strategies can help mitigate delays caused by RAC audits...more

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