CMS to launch RACs for Medicare Advantage

CMS released a request for information (PDF) that outlined the expansion of Medicare’s Recovery Audit Program, a program that has drawn the scorn of hospitals and doctors. In that program, the government hires private companies called recovery audit contractors, or RACs, to comb through medical records at hospitals and doctor offices and find instances of where Medicare is paying too much money. Providers have characterized RACs as administrative burdens and argued auditors have clear incentives to hunt for overpayments even when they may not exist. RACs are paid an amount that is contingent on how much money they recover for the government. Those same complaints are likely to extend to Medicare insurers, which, if found to have improperly billed, could have to forfeit millions of dollars back to Medicare if the program gets off the ground. But the CMS touts RACs as a way to ensure taxpayer money is being spent appropriately. All comments on the Medicare Advantage RAC program are due by Feb. 1.