The Exaggeration of the Tentative Notices of Overpayment

Over the past few days, with all the rain that we have been getting, I have noticed that ants are invading my house.  FYI: I am fine with bugs…just not in my house.  Each morning I wake up and I see an ant, I (a) complain to my ever-patient husband; and (b) fantasize about bulldozing the house.  Obviously, I would never bulldoze the house.  This is merely an exaggerated, reactive thought.  A better idea, rather than bulldoze the home, would be to get an exterminator, thus killing only the yucky ants, not squashing the whole home.

Exaggeration is a representation of something in an excessive manner.

So to, are the Tentative Notices of Overpayment (TNOs) that Medicaid providers are receiving from the Recovery Audit Contractors (RACs) exaggerations.  The TNOs are a representation of something in an excessive manner.

For example, Public Consulting Group (PCG) conducts an audit of 100 claims from 30 Medicaid clients.  The entire amount billed by the provider for those 100 claims is (I’m making up numbers) $10,000.  Then PCG sends a letter to the provider stating that the provider owes $760,000.

$760,000? From $10,000? How does $10,000 turn into $760,000? It’s called exaggeration…oh, I mean…extrapolation.

To show you how exaggerated the RAC audit figures are, I decided to show you a Decision written by a Department of Health and Human Services (DHHS) Hearing Officer.  Mind you, generally, I disagree with 99% of the decisions from DHHS. But, a broken clock is right twice a day, right?

I had a client that PCG determined owed $702,611.00.

After showing the records to the DHHS Hearing Officer, DHHS decided:

PCG Decision

I know, the font is too little.

Here it is blown up:

photo (3)

$ THREE HUNDRED THIRTY SIX DOLLARS

There is something patently wrong with an audit process if the auditor tells the auditee that the auditee owes $760,000 and the principle (DHHS) does not even agree with the agent (PCG) and does not reduce the amount by 10%…or 20%….or, even 50%.  Oh no, (mind you, I am no mathematician) reduces the amount by 99.975%.

But PCG, like me, would rather bulldoze the house…

About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on June 13, 2013, in Uncategorized. Bookmark the permalink. 8 Comments.

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