Archive for December, 2019

The Medicare Bounty Hunter System Will Soon Be Seeking Recoupment in Your Service Area

December 31st, 2019

Recovery Audit Contractors (RAC) have brought Medicare audits based upon the bounty hunter system to your area of service. Many times the RAC charge a recoupment without even backing up the claims in subsequent administrative hearings.

By Kenneth J. Haber, Esq

Mr. Haber is a former Assistant United States Attorney and former Senior Attorney for the Office of Inspector General – United States Department of Health and Human Services.  After leaving federal service, Mr. Haber founded his firm in 1984, and has been servicing healthcare practitioners ever since.

Doctors Beware- The RAC attack is in a service area covering you. Don’t believe them when they say: I’m from CMS and I’m here to help. RAC stands for Medicare Recovery Audit Contractors.  Medicare Administrative Contractors (MAC) have similar recovery functions as the RACs. The recovery function of each is based upon the bounty hunter system and you are the game to be hunted on a percentage basis. Nobody will be sacred and above the fray.

The Centers for Medicare & Medicaid Services (CMS) back in 2005 announced initiatives to provide “clear guidance” on Medicare billing and a new demonstration project using Recovery Audit Contractors (RAC) as part of CMS’ further efforts to assure accurate payments. The demonstration used the RACs to search for improper Medicare payments that may have been made to healthcare providers and that were not detected through existing program integrity efforts. The RACs are reimbursed based upon funds recovered [it has been from 9% to 12.5% in various RAC contracts]. They are in essence bounty hunters. They do not respect the three-year rule. The RACs were so successful that they became a permanent fixture with CMS. They routinely hunt physicians and other providers on a percentage basis. You do not want to come within their line of sight.

Every physician’s practice must have a strong compliance program to avoid being hit for 100’s of thousands of dollars and more in recoupment. A compliance program detects and corrects errors in your billing documentation, in advance. Properly documented medical and billing records are now a must. Legitimate, fully demarcated reconstruction of records is sometimes even possible as a prophylactic precaution for earlier erroneous records. These RAC’s do not respect the three-year rule because they start with old claims to begin with, find what they purport to be errors and then they extrapolate. Literally, it is repay $300,000 or $500,000 please, based upon the review of a small population of records. From the physician’s perspective, it does not matter if he is visited by a RAC or a Medicare Administrative Contractor [MAC], just as it makes no difference to agoat as to who is its hunter. The goat is just as dead regardless of who hunted it.

When you come within the cross hairs of such a hunter RAC or MAC, it would be best for you to get your own hunter on your side. Call the Law Office of Kenneth Joel Haber, PC at 301-670-0016.