Audits, Audits, Everywhere, But Not Much Fraud In Sight…

Now that we have 3 Recovery Audit Companies (RACs) going strong in North Carolina, expect exponentially more Medicaid audits. And across the spectrum of types of health care providers.  Already RACs are auditing behavioral health, dental providers (although this is only the beginning of dental audits), and neurological centers.

But, as reported in the January 2013 Medicaid bulletin, inpatient hospital medical audits and outpatient lab services should be undergoing RAC audits now. So this means that Duke, UNC, Rex Health Care, and LabCorp are, most likely, busy gathering documents for audits.

If a small dental provider or health care provider receives a Tentative Notice of Overpayment for $400,000-2 million, I can only imagine the staggering number that the RACs are claiming the hospitals and laboratory companies owe.  My guess is, since the RACs receive a percentage from the recoupments, that Duke’s bill may be in the billions.

Then, if these RAC audits of behavioral health and dental practices are indicative of the quality of RAC audits on the hospitals, 99% of the claimed overpayments will be incorrect. I guess the RACs hope that the hospitals are so big that they will just hand over the money.  But, instead, I foresee a fight.

The good news? I will have so much material that I can continue to blog for years to come.

The bad news? With all these audits and legal fees, let’s hope the Medicaid recipients do not become lost.  Let’s hope that too many health care providers do NOT go out of business due to these audits.  Let’s hope too many health care providers do NOT decide to give up accepting Medicaid. Because if too many providers leave the Medicaid arena, recipients will have nowhere to go.

Already, I’ve heard so many providers tell me, “Once I get through this mess (meaning appealing the audit results) I will never take Medicaid again.” While I understand the reason for providers saying this, it saddens me to think of the quality health care providers that Medicaid is losing because of ineptness of RACs.

Perhaps the RACs have just thrown the nets extra-wide hoping to undercover some fraud, but, so far in my practice, there has been zero under-covering of fraud, but lots and lots of paperwork nitpicking.

Posted on April 11, 2013, in Dentistry Services, Division of Medical Assistance, Health Care Providers and Services, MCO, Medicaid, Medicaid Audits, Medicaid Fraud, Mental Health, NC DHHS, North Carolina, Outpatient Behavioral Health, Tentative Notices of Overpayment and tagged , , , , , . Bookmark the permalink. Leave a comment.

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