San Diego health system challenges RAC procedures in court

A San Diego health system has filed a complaint in federal court challenging everyone's favorite CMS activity, the Recovery Audit Contractor program.

The suit, which was filed by Palomar Pomerado Health, argues that procedures used by recovery audit contractors aren't kosher. Specifically, it's arguing that contractor PRG-Schultz International unlawfully reopened a Palomar claim during the RAC demonstration project without showing the the "good cause" required by Medicare. 

This puts another controversy at the feet of PRG-Schultz specifically, which has taken fire for denying almost all of the Medicare inpatient rehab claims it reviewed in California during the demonstration project.

To learn more about the challenge:
- read this Modern Healthcare article (reg. req.)

Related Articles:
RAC program moves ahead after delay
Lawmakers question California Medicare audits
RAC activities suspended because of protests

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