Congress wants Medicare auditors to face their own review

Lawmakers call on the Government Accountability Office for a study on the impact of multiple audits of physician and hospital Medicare claims.

By Charles Fiegl amednews staff — Posted July 13, 2012

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A bipartisan group of lawmakers is questioning the role auditing contractors should play in the Medicare program, saying the audits place burdensome requirements on physicians and hospitals.

Five senators and six House lawmakers called on the Government Accountability Office to review contracted Medicare auditors, which include Medicare administrative contractors, recovery audit contractors and program safeguard contractors. The GAO should study the coordination of audits and contractor interactions with physicians and hospitals, the lawmakers wrote in a June 26 letter.

“Health care providers are responsible for interacting with, and responding to, these contractors,” the letter stated. “In order for this contractor oversight to at once be effective at detecting improper payments and not unnecessarily burdensome to providers, it must be undertaken subject to a coherent strategic plan, consistent standards and active coordination.”

The number of auditing initiatives in Medicare has grown as the federal government has worked to cut billions of dollars in fraud and waste from the health care entitlement program. During fiscal year 2011, recovery audit contractors, or RACs, found $939.4 million in over- and underpayments to hospitals and doctors. A majority of the errors resulted in money being paid back to Medicare, while a minority of claims reviews produced higher pay to doctors and facilities for past services.

Lawmakers and physicians have voiced concerns about the aggressiveness displayed by contractors, with some calling the RACs “bounty hunters.”

The American Medical Association has urged the Centers for Medicare & Medicaid Services to undertake such a review of auditors, said AMA President Jeremy A. Lazarus, MD. The Association was pleased to see Congress ask the GAO to examine the programs.

“As we recently noted to Congress, physicians spend a great deal of time determining which contractor is auditing them and which guidelines are necessary for response,” Dr. Lazarus said. “This creates additional burdens for physicians and hinders efforts to effectively combat fraud and improper payments.”

The congressional letter requested the GAO to review specific contractor activities. They asked:

  • What process the CMS uses to oversee audits.
  • How CMS coordinates five auditing programs to reduce duplication, and whether there is evidence of physicians or facilities being subject to multiple, overlapping audits.
  • What steps CMS takes to prevent duplicative audits.
  • Whether CMS has a strategic plan to coordinate and oversee auditing activities.

The letter was signed by Sens. Max Baucus (D, Mont.), Tom Carper (D, Del.), Tom Coburn, MD (R, Okla.), Charles Grassley (R, Iowa) and Orrin Hatch (R, Utah), and Reps. Charles Boustany, MD (R, La.), Diana DeGette (D, Colo.), John Lewis (D, Ga.), Cliff Stearns (R, Fla.), Fred Upton (R, Mich.) and Henry Waxman (D, Calif.).

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