Audit companies to begin examining health-care providers' Medicare records

Private audit companies will soon begin examining Medicare records in states across the nation to see if health-care providers erred when billing the Federal program. (Source: "Audits Sting Hospitals, Physicians," Associated Press, March 1, 2008.) A three-year test of these audits, conducted in only three states, returned more than $300 million to the Federal government. These "recovery audit contractors" will begin audits in 19 states this spring, expand to five additional states by the fall, and reach all 50 states by 2010. Health-care providers and other critics "say that contractors have too much incentive to question as many claims as possible. That's because they get to keep about 20% of the overpayments." However, government watchdog groups praise the audits. The Office of Management and Budget estimates that Medicare payment errors total about $10.8 billion a year.

According to a report from the Centers for Medicare and Medicaid Services (CMS), the audits will not be expanded to Ohio until January 2009 or later. (Source: RAC Status Document 2007, Appendix D, page 31, CMS.)