Congress Pulling Back the Reins on Medicare RACs

Recently, The New York Times ran an eye-opening piece on how Congress, in effect, shut down Medicare Recovery Audit Contractor (RAC) audits of inappropriate inpatient stays until March 2015. In recent years, these audits have been tremendously successful, accounting for over $8 billion returned to the government since 2009.

Undoubtedly, mounting pressure from the hospital industry caused Congress to halt this successful program. Indeed, the article quoted Marsha Simon, an expert on health policy and legislative strategy in Washington, who said, “They’ve been brought to a halt by their very success.”

By diverting RAC resources away from a known cause of substantial overpayments, Congress has left a gaping enforcement hole over billions of Medicare dollars. Fortunately, qui tam whistleblowers have been the driving force behind dozens of successful False Claims Act recoveries involving allegedly inappropriate inpatient stays. Just a few weeks ago, Nolan Auerbach & White announced its client’s case recovery of $36 million against Dignity Health, arising out of allegations of inappropriate one-day stays.

More information for whistleblowers is located at the Nolan Auerbach & White website.