I thought I’d begin today’s rumination by dispensing a bit of just-uncovered wisdom; having wide feet in and of itself does not guarantee that one is standing on steady ground. Allow me to offer one literal and one figurative example.

This morning, I was making my usual run to purchase a 44-ounce unsweetened iced tea at my local Speedway store (a Midwestern gas station-mini-mart chain) against the backdrop of rainfall in the Greater Milwaukee region. I took about four steps into the store and promptly slipped on a wet spot on the floor, quickly losing footing under my size 12 wides. I was able to catch myself before I made any more of a rush hour spectacle of myself. To Speedway’s credit, this morning’s iced tea was complimentary due to the apologetic clerk’s self-flagellation for not putting down a mat across the floor, thereby keeping my lifetime record of never hiring an ambulance-chasing attorney intact. Little did she know I’m a singer and not a dancer…

Upon my arrival at the office this morning, I was greeted by an article that should be of great interest to all providers adversely affected by government audits. A representative of the Senate Finance Committee told an audience at the just-concluded Health Care Compliance Association conference in Las Vegas that the Committee will soon be issuing an open letter to healthcare providers. The purpose of the communique is to solicit advice on the best ways to prevent waste, fraud and abuse in Medicare, Medicaid and their many offshoots.

On April 24th, this same committee held a hearing entitled “Anatomy of a Fraud Bust: From Investigation to Conviction”. It was at this hearing that Senator Orrin Hatch (R-Utah), the ranking minority member of the Finance Committee, announced his intention to solicit provider input. In the absence of the letter, the Committee has apparently been inundated with complaints from providers regarding auditing tactics. The bulk of the ire has been focused on the Zone Program Integrity Contractors (ZPIC) and that less-than-popular ongoing scourge of the hospital community, the RACs.

As the reader knows, I’m more than happy to share clearly defined opinions of both of these outside contractors. Bluntly, gathering the organized input of the provider community is overdue. Yet I would caution the reader, as I did with another such open letter issued last week, to consider the source of the request and the backdrop under which it occurs. The committee hearing from the 24th was commenced with two agendas. On one side was Senator Max Baucus (D-Montana), attempting to point to successes of government audits in the hope of propping up the thesis that states that fraud & abuse collections will pay for health care reform. On the other side is Senator Hatch, whose party’s ultimate mission is to vastly redesign the Medicare program into some kind of an amorphous voucher program.

Given this, there are reasons not to trust the motives of the minority portion of the Committee on this particular subject, but we are all fully aware that the RAC and ZPIC processes appear to be deliberately designed so that providers are at a disadvantage. The RAC program in particular has been problematic in that CMS continues to tweak the program to make it harder for providers to respond to incorrect audit findings in a cost-effective manner. As the majority of the contentious issues revolve around short hospital stays and observation status, it would appear that the RAC program could be formally concluded if CMS would only clarify these standards. It would be much more cost-effective for all concerned than the current model. To complicate matters, the boastful and glowing quarterly reports on RAC results that have been released by CMS thus far crumble under the realities of provider appeal results.

Yet something is missing. One set of entities that is more responsible than any other for Medicare’s haphazard payment practices appears once again to be avoiding the spotlight. I speak of the Medicare Administrative Contractors, who have been allowing Medicare benefits on claims that had no business being paid for decades, all without consequence. If the effect of a set of policies is studied in the absence of studying the cause, only half of the story has been written. Providers would be wise to consider this in any testimony or remarks submitted to the committee.

While this announcement was being made, I came across interesting news on a live broadcast by the RACMonitor team from the same conference. They had a guest on their broadcast yesterday afternoon stating that she has now seen Medicaid RAC activity in the states on New Jersey and Kansas. While the fate of the Medicaid RAC program now hangs on the looming Supreme Court decision regarding PPACA, it is no less distressing to learn that activity that has done very little for the Medicare Trust Fund is now reaching into Medicaid with their error-prone tentacles.

I saw more than just my own wide feet drop in the last day and a half, and only my own dealt directly with rain and iced tea. With regard to the other two, I am less than thrilled at the beginnings of the Medicaid RAC program given recent history, but I couldn’t be happier that the RAC and ZPIC contractors and their processes are finally being put under a credible and critical microscope.