This article misses the underlying issues that are - legitimately - much more complicated than they are asserted to be. The entire RAC audit process itself is subjective and inconsistent, the specific standards are unclear and the private auditors are incentivized to take overly severe positions, causing providers to appeal administrative determinations.
The audit appeals process itself is very difficult, lengthy and costly, and the administrative process thereafter will end up in court.
In my opinion, CMS’ decision to settle this now on these terms probably actually is in the best interests of the government and tax payers. It is the private audit firms that are squealing now because they won’t collect the level of bounties that they dreamed of collecting.
all the RAC’s charge the feds/states/Health plans between 10% to 25% of the dollars recovered e the quite the scam they got going