Practice Economics

Auditors collected $57 million from physicians in 2013


 

References

Auditors with the Centers for Medicare & Medicaid Services collected more than $3 billion in overpayments from health providers in 2013, including nearly $57 million from doctors, according to a CMS Sept. 29 annual report to Congress.

Recovery audit contractors (RACs) corrected a total of $3.75 billion in improper payments in fiscal 2013, of which $3.65 billion were in overpayments, the report found. Underpayments made up $102 million of the incorrect fees. Physicians were responsible for $56.8 million of overpayments identified. Underpayments to doctors totaled $1.2 million in 2013. Overpayment recoveries from all health providers were up $1.3 billion from those collected in 2012, according to last year’s report.

RAC payment corrections by provider type, FY 2013

RAC payment corrections by provider type, FY 2013

After contingency and administrative costs, the RAC program returned $3 billion to the Medicare trust funds. Meanwhile, RACs received from 9% to 12.5% of the inaccurate payments they identified. In fiscal 2013, auditors were paid $301.7 million in contingency fees, according to the report.

The outcome of audit appeals varied widely depending on the type of provider. Appeals decisions were made in 720,416 Medicare Part A claims and 116,433 Part B durable medical equipment (DME) claims in fiscal 2013. Those numbers include first-, second-, third-, and fourth-level appeal decisions, and may count the same claim multiple times. Of total claims appealed, 31% were associated with overpayment findings. Sixty percent of Medicare Part B DME decisions were overturned in providers’ favor, while only 11% of Part A claims were overturned on appeal.

agallegos@frontlinemedcom.com

On Twitter @legal_med

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