Tag Archives: Social Security Act

2013 CMS RAC REPORT SHOWS DOCTORS IN SOME STATES PAY 18 TIMES MORE RECOVERY FEES

The Centers for Medicare & Medicaid Services (CMS) recently released its annual report to Congress:   Recovery Auditing in Medicare for Fiscal Year 2013: FY 2013 Report to Congress as Required by Section 1893(h) of the Social Security Act.

The report is full of statistics on the Medicare auditing program.  It presents a picture of “profit”, that is, less money is spent by the government on running the auditing program than is recovered.  It is “cost effective” to use government parlance.   (This calculation does not account for the costs born by the health care providers.)

One would think that from state to state, the amount recovered “clawed back” by the Recovery Audit Contractors (RACs) would be about the same, but it is not.   See the Figure below.

2013_RAC_DATA_Analysis_doctorsBy taking the amount recovered in a state and dividing it by the number of doctors in the same state, we can see that in Mississippi the recovery per doctor was around $18,000 dollars.   But in Maryland, it was around $1,000 dollars – an eighteen times difference! 

It would be interesting to learn more about why this occurs.

 

2013 CMS REPORT ON RACS SHOWS MASSIVE DIFFERENCES IN RECOVERY PER CAPITA

The Centers for Medicare & Medicaid Services (CMS) recently released its annual report to Congress:   Recovery Auditing in Medicare for Fiscal Year 2013: FY 2013 Report to Congress as Required by Section 1893(h) of the Social Security Act.

The report is full of statistics on the Medicare auditing program.  It presents a picture of “profit”, that is, less money is spent by the government on running the auditing program than is recovered.

The report, however, does not address the discrepancies between states for recovery “claw back” of Medicare claims.   The calculation is shown in the figure below.

2013_RAC_DATA_AnalysisWhen we chart the amount recovered and compare it to the number of persons living in the state, the difference is vast.   In Maine, for example, there was $2 per state resident recovered.   However, in North Dakota, there was $36 dollars recovered for each resident.

Does this mean that the health care providers in some states are being more strictly audited than in others?   The CMS report does not give any clue to the answer.