RAC Auditors Tap Providers for $780M in Three Months

Recovery Audit Contractors (RAC) collected a record $744.8 million in overpayments to providers during the last three months of 2012, the Centers for Medicare and Medicaid Services (CMS) reported.

The auditors also had underpayments returned totaling $34.4 million, bringing the total adjustments to a record $779.2 million for what amounts to the first quarter of the federal government’s Fiscal 2013.

During the same period last year RAC auditors collected less than $400 million in overpayments and less than $25 million in underpayments returned.

The number one reason providers are failing audits have been for medical necessity cardiovascular procedures. However in Region D, covering the American West, the number one reason was minor surgery and other treatment billed as an inpatient stay. Medical necessity neurological disorders had been the number one reason for failure in two of the regions, A (Northeastern U.S.) and C (U.S. South), a year ago.

The RAC auditors are on track to recover more than $3 billion in Fiscal 2013, which is slightly less than the $3.4 billion total recovered in the previous three years of the program.