New CMS Recovery Audit Contractor and Medicaid Integrity Contractor Audits

Description

The Centers for Medicare and Medicaid Services (CMS) is intensifying its pursuit of fraud, abuse and waste in federal healthcare programs. Most recently, CMS hired contractors to educate Medicare and Medicaid providers, review provider actions, audit claims and identify overpayments.

Recovery Audit Contractor (RAC) audits focus on Medicare Parts A&B claims. Between 2005 and March 2008, RAC auditors identified and collected more than $1 billion in improper Medicare payments. RAC audits will move forward in a number of states in early 2009.

Simultaneously with the RAC audits, Medicaid Integrity Contractors (MIC) are auditing individuals and organizations providing Medicaid services. MICs are currently underway in two regions of the country. Auditors are expected to perform 200 provider audits per month by May 2009.

Listen as our panel of healthcare attorneys explains the current Medicare and Medicaid enforcement environment, how RAC and MIC audits are being used to stamp out fraud, abuse and waste, and strategies for preparing for audits and defending against or appealing unfavorable findings.

Outline

1. Current Medicare and Medicaid enforcement environment
2. Recovery Audit Contractor Audits (RACs)
   1. Lessons learned from RAC demonstration project
   2. Best practices to prepare for audit
   3. Provider appeals
3. Medicaid Integrity Contractor Audits (MICs)
   1. Purpose of audits
   2. Who conducts audits?
   3. Providers subject to audit
   4. Provider selection process
   5. Best practices to prepare for audit
   6. Provider appeals

Benefits

The panel will review these and other key questions:

• How are RACs and MICs being used to identify and curtail wasteful spending in the Medicare and Medicaid programs?
• What are the most common mistakes that result in Medicare and Medicaid overpayment?
• What steps should providers take to ensure that their Medicare and Medicaid claims will withstand heightened CMS scrutiny during audits?
• What strategies should counsel for providers employ to defend against unfavorable audit findings and prepare for appeal?

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