The Government Accounting Office (GAO) released a report on March 31, 2010, which discussed the Centers for Medicare & Medicaid Services’ (CMS) RAC process.
The report mentions the RAC pilot program and the RAC process in general and essentially says this program is working.
The report then goes on to say, there shouldn’t be a need for the RAC program:
CMS did not establish an adequate process in the 3-year demonstration project or in planning for the national program to address RAC-identified vulnerabilities that led to improper payments, such as paying duplicate claims for the same service. CMS stated that one purpose of the demonstration project was to obtain information to help prevent improper payments. However, CMS has not yet implemented corrective actions for 60 percent of the most significant RAC-identified vulnerabilities that led to improper payments, a situation that left 35 of 58 unaddressed.
The GAO findings go on and can really make on ill as you get a view inside the incompetence of government programs.
Basically what this report is saying is, the RAC program is working, but we shouldn’t need the RAC program, the CMS should have it’s act together so it doesn’t screw up this bad.
The GAO then goes on to recommend action to fix the CMS shortfalls. Unfortunately the actions are bland governmental reactions: “the Administrator of CMS should develop and implement a process that includes policies and procedures…” and “The Administrator of CMS should designate key personnel with appropriate authority to be responsible….”
Unfortunately typical government mumbo-jumbo.
Let’s face it, the CMS isn’t going to change how it works, and the RAC process is the “easy” way to attack this problem.
Quite frankly, we at RACGuru don’t see things changing…aside from the RAC’s coming after more and more physicians.