RACs recoup $745M in overpayments

Recovery auditor (RAC) activity is continuing to grow into a formidable force for recouping Medicare overpayments, according to new data from the Centers for Medicare & Medicaid Services.

Medicare RACs recovered $744.8 million in overpayments during the first quarter of fiscal year 2013, which ended on Dec, 31. That puts the program at more than $3 billion in recoupments since October 2009.

According to CMS data, underpayments returned to providers also are on the rise, with RACs sending back $34.4 million during the first quarter. That compares to $109.4 million for all of fiscal 2012 and $16.9 million in fiscal 2010.

Three of the four RAC firms identified the medical necessity of certain cardiovascular procedures as a recurring issue, with a primary focus on the setting (e.g., billing at inpatient rates when outpatient was appropriate).

HealthDataInsights, which covers much of the West, Pacific Northwest and the Dakotas, said minor surgeries was its main recurrent issue, with the appropriate setting for the procedures often in dispute. Moreover, HealthDataInsights recently reached $1 billion in overpayment recoupments, and has accounted for 36 percent of collections to date, the RAC announced earlier this month.

For more:
- read the CMS data sheet (.pdf)
- here's the HealthDataInsights statement