I just read an article published by Modern Healthcare, the recovery auditor contractors (RACs) recouped some $3.75 billion in overpayments made to hospitals and physicians in 2013. I am not sure how that achieves the ranks of bragging rights, but for the RAC trade group, it apparently does. And in the article, this fact is followed by an out-and-out lie, which states that only 18.1 percent of all claims that providers took to Medicare’s appeal process were overturned in their favor.
First of all, how in the heck would the government have any clue as to the disposition of claims within a 12-month window when it takes close to three years to get those claims to the ALJ level? Maybe they should have been a bit more truthful and said that, based on the disposition of appeals that were able to be adjudicated during the same calendar year as the findings, 18.1 percent were reversed on appeal. I mean, I am dumbfounded. I read that and was slack-jawed.