Press Releases

Today, U.S. Congressman Paul A. Gosar, D.D.S. (AZ-04) released the following statement after spearheading a letter to the Secretary of the Department of Human and Health Services (HHS), Sylvia Burwell, calling on the Department to reform the Medicaid Recovery Audit Contractor (RAC) program:

“Since its launch in 2010, we have heard from medical providers that there have been significant problems associated with the Medicare RAC program and we are beginning to see similar problems as states begin to implement the Medicaid RAC audits. While everyone can agree that it is important for CMS to fight fraud and abuse, the execution of the RAC program has been poorly implemented and raised serious concerns.

“RAC auditors are paid on a contingency basis, which incentivizes the application of punitive damages at the expense of finding and correcting fraudulent activity. As a result, the backlog of appealed audits has grown to 460,000 in just under two years – preventing practitioners from receiving swift reprieve from erroneous fraud accusations. Many of these accusations have no merit and RAC audit decisions are being overwhelmingly overturned by the Department of Health and Human Services Office of Medicare Hearings and Appeals (OMHA) after years of costly defense on behalf of accused health care providers.

“Now more than ever, we cannot penalize our medical providers with burdensome and punitive regulations so contractors can line their pockets. CMS must ensure that the RAC program is fair, transparent and allows medical practitioners the opportunity to learn how to fully operate under the applicable regulation.”

Background:

The RAC program was established to identify improper payment and instances of fraud within the Medicare and Medicaid programs. CMS tasked private entities, called Recovery Audit Contractors, with identifying and collecting improper payments made in the Medicare fee-for-service (FFS) program. 

Rep. Gosar’s efforts to reform the Medicaid RAC program has been endorsed by the American Dental Association as well as 74 members of the House of Representatives. The letter can be found HERE.

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