George B. Breen, a Member of the Firm in the Health Care and Life Sciences practice, based in the Washington, DC office, was quoted in an article titled "Medicaid's Mounting Audit Pressure."
Following is an excerpt:
As more eligible people sign up for Medicaid in 2014 and a new auditing program that rewards contractors for identifying improper payments expands its reach, doctors and other health care professionals who treat Medicaid patients are being warned to prepare for increased audit activity.
MICs and RACs differ in fundamental ways. RACs, established in 2012 under the ACA, are paid based on the amount of money in improper payments they identify. MICs aren't paid a contingency fee. While MICs conduct postpayment auditing to identify overpayments, RACs are instructed to look for both overpayments and underpayments, said George Breen, a partner at the law firm Epstein, Becker & Green. RACs are overseen by the states, while the Centers for Medicare & Medicaid Services runs the MIC program.
Another feature that distinguishes the two audit efforts are the RACs' ability to extrapolate data, Breen said. "RACs will look at claims for a period of time, determine an error rate and then extrapolate and identify overpayments based on claims analysis that they did. So the [overpayment] numbers can be very significant."
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