Thomas Hutchinson Quoted in “GAO Report Puts Pressure on CMS to Wrap Outstanding RADV Audits, Hire MA RACs”

Health Business Daily

Thomas E. Hutchinson, a Strategic Advisor for EBG Advisors, Inc., was quoted by Health Business Daily, in “GAO Report Puts Pressure on CMS to Wrap Outstanding RADV Audits, Hire MA RACs.”

Following in an excerpt:

Thomas Hutchinson, strategic advisor to the Epstein, Becker & Green, P.C. health care law firm and a former top CMS Medicare plan official, says it’s already well known that GAO doesn’t agree with how CMS calculates coding intensity for plan payment purposes, and that it appears GAO “went out of their way to rehash old criticisms over how coding intensity is measured.”

And GAO is somewhat misguided in its contention that CMS is not selecting the plans to audit that the government could get the most revenue back from, he argues. “I don’t see CMS doing RADV as some revenue-generating opportunity for the federal government. Yes, you could do audits on really big plans, so if you had really big extrapolation, you’d have really big recoveries, but you’d still be missing huge parts of the program,” points out Hutchinson. “If you were to just focus the 30 audits on the contracts that could generate the most revenue. … the other plans could sit back and get a free pass. But CMS is trying to ensure that there is integrity throughout the program. It shouldn’t just be a revenue grab by the federal government.”