Carrie Valiant, a Member of the Firm in the Health Care and Life Sciences practice in the Washington, D.C., office, was featured in an article about how Recovery Audit Contractors audits are becoming even more threatening as President Obama promises increased focus.
The article discussed how providers are facing more threats than ever before and have to act immediately to protect themselves since President Obama recently promised to bring in more high-tech bounty hunters to root out health care fraud. The audits will be more intense and the bounty hunters, known officially as Recovery Audit Contractors (RACs), will have great incentive to find problems that might have gone overlooked in years past.
Valiant stated that the focus on health care fraud is nothing new, but the resources devoted to detecting it and recovering the money are greatly scaled up. She noted that although politicians use the issue to make themselves look tough on fraud and waste of taxpayer funds, it would be a mistake for providers to focus only on outright fraud within their organizations.
“As most health care providers know, this isn’t about real fraud,” Valiant said. “It’s about claims that are slipping through the cracks because hospitals don’t have edits in place to look at certain kinds of claims before they are released. It’s about documentation glitches and other errors.”
Valiant urged providers to analyze their systems for the weaknesses that can let such mistakes get past people who should know better. Also, she said compliance officers should make sure that others in the organization understand the risk from RAC audits and how to respond to them.
“You need to make sure that when there is a request for medical records from an auditor, it trickles up to the compliance office and doesn’t just land at the medical records department and handled as a routine request,” Valiant said. “I’ve seen that happen before, and you don’t get a whole lot of time to respond to these requests. Sometimes it’s all you can do to get the records together, but sometimes upfront attention by the compliance officer can nip some problems in the bud.”
Valiant said that the compliance officer can make sure that the medical record department provides all records requested, because a missing record can result in your being dinged for an overpayment. On a typical request for records, the medical records department in many hospitals is focused on simply complying with the request by handing over some records quickly, she continued. Then they deal with any additional requests for missing records later. But that is not the way to handle a RAC request, stated Valiant.
“You have to make sure every piece of paper they’re asking for is provided, whether it’s in your official medical record or somewhere else, part of a different type of record,” Valiant said. “Hospitals have different definitions for what constitutes the medical record, so you have to make sure you’re giving them what they actually are looking for.”