May 22, 2015
Area(s) of Interest: Payor Issues and Reimbursement Practice Management Public Payors
The California Medical Association (CMA) issued a strong endorsement for the “Fair Medical Audits Act of 2015,” introduced today by U.S. Representative George Holding of North Carolina. The legislation addresses many concerns that physicians have with regard to the extraordinary lack of transparency and expensive, time-consuming and often unfair processes that plague the current Medicare audit program.
Representative Holding declared it time to fix the broken audit program: “Put simply, patients achieve the best health outcomes when practicing physicians do just that – practice medicine. My bill will bring transparency and fairness to the audit process so doctors can spend more time caring for their patients and less time proving their innocence. Medicare frauds must be found and severely punished, but not at the cost of the independent practice of medicine.”
Currently, Medicare pays recovery audit contractors (RAC) on a contingency basis to find overpayments to health care providers, providing these contractors with undue monetary incentives to audit doctors. This legislation would establish incentives for RACs to make more accurate audit findings and increase educational efforts to help physicians avoid common mistakes. Since its inception in 2006, CMA has worked closely with the Physicians Advocacy Institute to advocate for more fair and transparent medical audits.
CMA President Luther F. Cobb, M.D., lauded the legislation, noting: “It is time to address fundamental problems that have contributed to the backlog of audit appeals and caused a great deal of unnecessary expense and confusion for physicians in California.”
Robert W. Seligson, President of the Physicians Advocacy Institute and EVP/CEO of the North Carolina Medical Society, also hailed the proposal, stating, “Physicians and their advocates across the nation commend Congressman Holding for his leadership on this critically important issue.”
Representative Holding is a member of the House Ways and Means Committee, which has jurisdiction to consider legislation to reform the RAC program.
For more information, please contact CMA’s Molly Weedn at (916) 551-2069, or PAI Executive Vice President Kelly Kenney at (312) 543-7955 or email@example.com.