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Letter: RAC audits could prevent doctors from accepting Medicare

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Posted: Tuesday, October 8, 2013 12:00 am

Attorney General Eric Holder declared that Medicare RAC (Recovery Audit Contractor) audits, implemented under the Affordable Care Act, “will have a substantial impact on deterring fraud and abuse, protecting patients and the elderly from scams, and ensuring that taxpayer funds are not stolen.”

Mr. Holder, I respectfully disagree. Much of what is deemed “fraud” by the federal government is simply the average medical provider’s inability to live within the governments vague, offensive and arbitrary regulations while actually caring for patients.

The newly aggressive Medicare RAC program governed under the act continues to cause mayhem and devastation within our health care system. RAC auditors viciously target legitimate providers and demand a refund of payments earned as far back as 5 years ago. They fabricate rules and regulations in order to justify denials, recoup the money based upon these prejudicial denials and continue to ignore constitutional standards.

Coincidentally, RAC auditors are paid on a contingency basis; they get paid a percentage of denied claims. So common sense would ask: What is their incentive to approve a claim? The answer is simple: Nothing. They play by their own set of rules and make it impossible for providers to comply with a moving target. The effects: Medical service providers continue to drop Medicare beneficiaries, crucial health care professionals are handing over the keys and desperate patients are left without the necessary care.

In a recent communication I received from President Barrack Obama regarding RAC audits, he emphasized that a purpose of the Affordable Care Act is to support and promote the growth of small businesses. However, thousands of fundamental small businesses are continuously closing their doors due to the overwhelming burdens caused by RAC audits, and vital medical providers are steadily becoming nonexistent. In reality, the Affordable Care Act is successfully destroying small businesses.

RAC policies succeed in extracting money from honest health care providers and fail any sensible test of objectivity or fairness. If something isn’t done soon, the pendulum will have swung too far one way and may not swing toward the center in time to preserve our health care system as a whole.

Sara Beck


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Welcome to the discussion.

1 comment:

  • Joanne Bobin posted at 5:09 am on Tue, Oct 8, 2013.

    Joanne Bobin Posts: 4488

    Understandably, I'm a bit confused by the wording of this letter. Ms. Beck states:

    "Attorney General Eric Holder declared that Medicare RAC (Recovery Audit Contractor) audits, implemented under the Affordable Care Act..."

    Is she referring to CHANGES to the RAC audit program under the ACA?

    Since RAC audits were made mandatory under the 2003 Medicare Modernization Act, and under the ACA the program was expanded to include Medicaid and Medicare Parts C & D (Medicare Advantage Plans and the Medicare Prescription Coverage Plans), I'm not sure what the actual issue is here.

    The letter implies that these onerous audits were created SPECIFICALLY under the ACA (Obamacare), thus destroying "small businesses."

    Which "small businesses?" Small medical offices? Or other private industry small businesses?

    If RAC audits were in existence prior to the implementation of the ACA, why are they suddenly "destroying small businesses?"

    RAC auditors make a contingency of 20 Cents on each dollar recovered due to fraudulent billing or inaccurate billing. Unless there is evidence that these auditors are also committing fraud by performing wrongful audits, citizens and Medicare recipients should be pleased with the results.

    According to a USA Today article dated June 2013:

    "During the past four years, the government has recovered $14.9 billion in Medicare fraud money, due in large part to the 2010 health care law, also known as the Affordable Care Act. The law allowed the government to analyze data to spot indications of fraud and stop paying providers."

    14.9 BILLION. Certainly nothing to sneeze about, pardon the pun.

    Also in this article:

    "But there has been a special focus under the Affordable Care Act."

    Administration officials plan to announce the new fraud numbers Thursday as they push for more help from seniors in fighting fraud. (by reporting payments made to providers they had never seen).


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