We now find ourselves in the month of May. This time of year is a unique time for all of us. The new baseball season is in full swing, the rains of April bringing forth a world of color from flower beds everywhere and the days begin to give us a little more sunlight, bringing with it the anticipation of summer days ahead.
And me? Lo and behold, I’m a Winter guy. For me, Spring brings with it the promise of allergens, bugs (my only pathological fear) and the promise of the long humid days that continually aggravate both of my afflictions. Fear not, for a predilection for Winter makes me uniquely suited to be a compliance officer in these difficult times.
Being “blessed” with my chosen Spring temperament will suit me well in the coming days, months and years for the Recovery Audit Contractor program, which has now become known (fittingly) by its medieval torture device of an acronym – RAC.
Before I delve deeply into why the RAC’s are a fundamentally flawed idea whose time has apparently arrived, we must first gain perspective about how we have been brought to this point.
When we look to the government as a safeguard against the loss of tax dollars, we learn very quickly that there are portions of the U. S. Government that are not suited to the task. When we get to the individual department level, in many cases it becomes easy to draw sides both for and against a department continuing on the same path.
This cannot be said of the Office of Inspector General for the Department of Health & Human Services. The OIG has been a department section whose recoveries in dollars to the Medicare program have far outpaced their annual operating budget for many years. Billions of dollars have been returned to CMS per year due to the efforts of the OIG, with nearly $6 billion returned in the fiscal year of 2008 alone.
So why do we now have the RAC program?
The previous administration brought forward a philosophy, demonstrated in excruciating detail by companies such as Halliburton and Blackwater, that unfettered capitalism, in the form of independent government contractors, is the solitary panacea to all of the government’s ills as a structure. Rising out of this set of beliefs comes the RAC program, which in the sales pitch sounds like a fine way to return money to the Medicare program, until the fine print is magnified.
For every dollar returned to CMS through the RAC program, 22 cents will go to the contractors who discover the overpayments. As a taxpayer who pays into the Medicare program, I would be happy to pay some portion of recovered monies to a contractor if it was bringing forward a new and as yet unheard-of method of forensic auditing on its own that would lead to the return of dollars to a taxpayer-funded program. Instead, the RAC’s will make all of their incorrect payment determinations from CMS-proprietary computer software. All the contractors need do is enter data, run reports and send out letters either demanding overpaid dollars or requesting medical records. Apparently, this type of revolutionary thinking is worth 22% of recovered dollars to a federal program I pay into twice a month.
It gets worse.
The RAC program was designed for four regional contractors, each covering a different listing of states. When the permanent contractors were selected for the RAC program in October of 2008, two contractors who had been part of the Demonstration Project in previous years filed a grievance for being excluded from the permanent program. The settlement between the government and these orphaned contractors states that these two contractors will now work as subcontractors for two Permanent RAC contractors. Without conducting a single permanent audit, the program already has 50% more hands in the till than originally designed.
If common sense were entered into this complex equation, the shelf life of the RAC contractors would be fairly short. As it stands now, the RAC’s are here to stay, and are about to become an uncomfortable part of life for every portion of our healthcare delivery system. In the concluding part of this post, I’ll give the reader a blueprint for what is coming at the end of this month with regard to RAC activities, as well as a preview of best practices going forward should you be the recipient of correspondence from a recovery audit contractor.