Audits, big business and allegiances


It may not feel like it, but HME providers aren’t the only healthcare providers being audited like crazy by the government.

Hospitals are, too.

I was reminded of this last week when I saw a press release from a group called the American Coalition for Healthcare Claims Integrity (ACHCI).

Never heard of them?

According to the release, the ACHCI, founded in 2009, is a nonprofit “committed to working toward achieving 100% accuracy in payment claims submitted to public and private sector healthcare payors.”

It’s no surprise that among the group’s founding members are “partners in critical accountability initiatives, including the federal Recovery Audit Contractor (RAC), Zone Program Integrity Contractor (ZPIC) and Medicaid Integrity Contractor (MIC) programs.” Its mission: “educate policymakers and other stakeholders regarding the importance of healthcare integrity programs that help identify and correct improper payments.”

In other words, the ACHCI is a lobbying group for the auditors—a true sign that the business of auditing has become a big business.

Anyway, back to that press release. The ACHCI is decrying CMS’s recent—and quiet, according to the release—decision to suspend RAC reviews of short-stay inpatient hospital claims until March 31, 2014.

From the release: “The CMS Recovery Audit Program has successfully recovered more than $7 billion in improper payments since the program began in 2009. This new auditing interruption will amount to an estimated loss of nearly $2 billion for the Medicare Trust Fund, or more if the delay continues.”

ACHCI places the blame squarely on the American Hospital Association (AHA), whose complaints about the reviews, it says, have put increasing pressure on CMS to weaken the program. The group goes on to say that hospitals are responsible for 88% of the overbillings to Medicare.

I know an HME provider or two who would join the ACHCI in decrying the suspended reviews. Why should hospitals get what the group calls a “free pass” while HME providers continue to suffer?

Then again, the HME industry may be better off trying to ride the coattails of the AHA, which is working with Congress to reform the audit system.