Audits: ‘Guilty until proven innocent’

Wednesday, May 21, 2014

WASHINGTON – A subcommittee hearing on audits yesterday shows that lawmakers are getting the message.

“I have some serious concerns that the current system of post payment audits by recovery audit contractors (RACs) is resulting in a significant burden on some providers,” said Rep. Michelle Lujan Grisham, D-N.M., at a hearing held by the House Oversight and Government Reform Subcommittee on Energy Policy, Health Care and Entitlements, according to a bulleting from The VGM Group.

Officials from the Center for Program Integrity, the Government Accountability Office and the Office of Inspector General testified at the hearing.

In addition the RAC audits, lawmakers remain concerned with the backlog in appeals at the administrative law judge (ALJ) level. A Dec. 31 memo from the chief ALJ cited a backlog of 357,000 pending appeals and suspended assignment of hearings for appeals dating to July 15, 2013. It could be at least two years before those appeals get assigned to an ALJ. 

Rep. Mark Meadows, R-N.C., said it would take nearly 10 years to work through the backlog.

“We have a policy that says you’re guilty until proven innocent,” he said.

The HME industry is waiting for Rep. Renee Ellmers, R-N.C., to introduce audit legislation that would, among other things, increase education and outreach about improper payment, reduce error rates and require timely filing limits on claims.

Stakeholders are also expecting a pair of reports, possibly in June, from both the Senate Finance Committee and the Government Accountability Office (GAO) on audit issues, with a possible hearing with the Senate Finance Committee sometime after July 4.