Recovery Audit

News & Analysis as of

Health Care Reform Implementation Update August 2014

The Centers for Medicare and Medicaid Services (CMS) made announcements this week regarding the Open Payments system and the availability of Affordable Care Act (ACA) Consumer Assistance Program grant funds, issued a request...more

AHA Renews Complaints about OIG Hospital Compliance Reviews

The American Hospital Association (AHA) has renewed its complaints about OIG “hospital compliance reviews.” Last Thursday AHA Executive Vice President Rick Pollack sent a letter to Health & Human Services Secretary Burwell...more

Who Audits the Auditors?

Since the advent of Medicare in 1965, hospitals have bemoaned the cost and burden of Medicare audits. The complaints increased when CMS hired private contractors for the audits. They became deafening in 2009 with the advent...more

CMS Changes to Medicare Advantage and Prescription Drug Benefit Programs for Contract Year 2015

On May 19, 2014, the Centers for Medicare & Medicaid Services (“CMS”) issued a final rule, published in the Federal Register on May 23, 2014, that sets forth changes to requirements for Medicare Advantage (“MA”) and...more

CMS Proposes Rule That Would Expand Its Authority To Audit Medicare Advantage Plans

On April 30, 2014, the Centers for Medicare and Medicaid Services (“CMS”) issued a proposed rule to update payment policies and rates for inpatient hospitals (the “Proposed Rule”) that includes a provision with significant...more

Recently Released Data Show Current Status and Future of Medicare Integrity Efforts

Last week, CMS and the Government Accountability Office (GAO) published two reports concerning Medicare contractor developments. In the Medicare Fee for Service National Recovery Audit Program Quarterly Newsletter, CMS...more

For New Recovery Audit Contracting Cycle, CMS “RAC”s up Changes

Last month, the Centers for Medicare & Medicaid Services (CMS) announced important changes to the Recovery Audit Program. The agency had already begun the procurement process to find new Recovery Audit Contractors (RACs) in...more

CMS Issues FAQs for Inpatient "2 Midnight" Rule

CMS issued its first set of FAQs on the new 2 midnight inpatient admission standards [PDF] on September 26. In those FAQs, CMS stated: - Medicare Administrative Contractors (MACs) and Recovery Auditors are not to...more

Hospitals And Fraud Enforcement

The HHS Office of Inspector General has targeted hospitals for fraud enforcement. It is one of the OIG’s most important initiatives because of the impact it could have on reducing health care costs....more

CMS Publishes Annual Update On Recovery Audit Activity, Says Program Returned Nearly $490 Million to Medicare Trust Fund in 2011

On February 5, 2013, CMS sent Congress a report summarizing developments related to its Medicare recovery audit program for fiscal year (FY) 2011. According to the report (titled Recovery Auditing in the Medicare and...more

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