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Taxpayer Watchdogs Urge House & Senate Committees to Revive Prepayment Reviews for Medicare Claims
[November 08, 2018]

Taxpayer Watchdogs Urge House & Senate Committees to Revive Prepayment Reviews for Medicare Claims


Today, the Council for Citizens Against Government Waste (CCAGW) President Tom Schatz and National Taxpayers Union President Pete Sepp sent a joint letter to the House Ways and Means Committee and the Senate Finance Committee urging them to allow the Centers for Medicare and Medicaid Service's (CMS) Recovery Audit Contracting (RAC) program to establish a permanent, nationwide prepayment claims review process for Medicare claims.

The letter reads, in part:

"The Recovery Auditing in Medicare Fee-For-Service Report to Congress for Fiscal Year 2016, released o September 19, 2018, documented that Medicare is losing nearly $40 billion annually to improper payments, which echoes previous years' findings.



"Medicare's actuaries have (once again) reminded Congress that the program slips into insolvency in 12 years. It is unconscionable, therefore, that more than 95 percent of Medicare Fee-for-Service claims are paid without a review for billing accuracy, especially when CMS has at its disposal a RAC program with a proven track record of preventing improper payments.

"We respectfully urge you to grant CMS the congressional approval it requires to revive and make permanent a nationwide Medicare prepayment claims review program. Furthermore, we urge that the RACs be allowed to use their proprietary data analytics technology, which has been used with great success for Medicare post-payment claims reviews, to identify billing areas with a propensity for erroneous payments and help prevent such payments to providers before they occur. This type of improved oversight can include not only RAC prepayment reviews, but also other tools like Medicare 'smart card' technology, which the House of Representatives authorized in a pilot project earlier this year.


"Taxpayers and Medicare beneficiaries have waited patiently for decades for CMS to move away once and for all from the wasteful and inefficient 'pay and chase' program integrity model. Adding a significant prepayment review program, coupled with the current post-payment review program, is exactly the kind of private-sector best practice CMS is seeking to help prevent tens of billions in losses each year to protect Medicare now and in the future."

The Council for Citizens Against Government Waste is the lobbying arm of Citizens Against Government Waste, the nation's largest nonpartisan, nonprofit organization dedicated to eliminating waste, fraud, abuse, and mismanagement in government.


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