As if the issue of slashing Medicare reimbursement by 21% is not bad enough, the government is trying to get the money that you have already received for services rendered. On March 10th, President Obama issued a directive expanding the use of “payment recapture audits” to identify and recover overpayments.

Companies are being hired as auditors to review  your claim. They will then seek return of payments made over the amount the “auditors” decide it should have been.

The government thinks that this will be a great return of investment since the amount to be recouped will be far less than the cost for these audits. As a matter of fact, there is no investment, only gain since the auditing agents will only be paid by getting a percentage of the recovered money.

Needless to say, it is not in the best interest of the auditing companies to declare the reimbursements were correct. (hardly independent and unbiased agents)

President Obama lauds Medicare’s Recovery Audit Contractor Program (RAC) for its successful identification and recovery of improper payments.

Civil penalties for persons who receive overpayments from Medicaid are now up to $10,000 for a first offense and $30,000 for repeat offenses (for each item of care, service, or supply)

The real problem here is not that there is so much fraud as much as who is determining what constitutes fraud. With lack of proper medical knowledge and experience in health procedures and coding as well as questionable objectivity,  which side of the table is really collecting the money fraudulently- the doctor rendering service or the RAC?

If President Obama had been as diligent in auditing where money went with millions of dollars in bail out funds going to banks and brokerage houses, perhaps they wouldn’t need to turn to health providers and  be so “diligent” now.