I have presented on RACMonitor, I think, for 3 years. I’d have to ask Chuck Buck to be exact. Over the last three years, I have tried my best to get the message out – RAC Auditors do not know what they are doing. Always appeal the decisions. – I feel like on my blog and on RACMonitor I have screamed this message until I was blue in the face.
Apparently, a couple Senators have taken notice. Or their constituents complained enough. Senators Tim Scott and Rick Scott drafted a letter to the Comptroller of America. A comptroller is a “controller” of financial affairs for the Country. The comptroller is the police of our tax dollars.
A few months ago, Senators Tim and Rick Scott wrote the U.S. Comptroller and complained about RAC auditors.
It was a letter that was short and sweet. It asked three questions.
- How have states used the Medicaid RAC program to address strategic program integrity needs, including audits of managed care, and what are the lessons learned?
- What steps do the states and the Centers for Medicare & Medicaid Services (CMS) take to coordinate state Medicaid RAC program audits and other program integrity efforts? This includes existing Medicaid integrity programs such as the Unified Program Integrity Contractors, Payment Error Rate Measurement program, state auditors and Medicaid Fraud Control Units.
- How do states and CMS oversee the Medicaid RAC program and what mechanisms are in place to appropriately refer suspected cases of fraud?
As for the first question, RACs do address strategic PI needs – the very reason for their existence is to detect supposed fraud, waste, and abuse (“FWA”) by Medicaid providers. I’d like to hear the Comptroller’s answer.
As for the second question, they asked whether the States and CMS coordinate State Medicaid RAC audits. I don’t really care if the States and CMS coordinate State Medicaid RAC audits. So, I don’t care whether I hear the Comptroller’s answer to this.
The third question – “how do States and CMS oversee the Medicaid RAC program and what mechanisms are in place to detect FWA by Medicaid providers?” – I want to know that answer! I can tell the Comptroller the answer. The RAC Auditors are not supervised or overseen. If they were, they would audit differently; not try to find errors in every single audit conducted.
Maybe it’s time to get our Senators involved. While we’re at it, let’s talk about the Medicare provider appeal process, which is broken.