Medicare recently announced that it will be increasing the frequency of its audits under the Medicare Recovery Audit Program in the near future. Under the Recovery Audit Program, Medicare contracts with auditors who review the records of health care providers to determine if Medicare was incorrectly billed for services and if so, to determine the amounts of overpayments due back to the Federal Government. In the past three years alone, the Recovery Audit Program has resulted in the return of more than $300,000,000 to the Federal Government. Medicare has indicated that they will begin monitoring 19 states in the near future, s significant increase from the contractors’ current scope which has been in just three states. An additional five states will be added in October.

In order to help reduce the risk of significant repayment obligations to the Federal Government under a Medicare Audit, it is important to establish a Medicare Compliance Program and to periodically verify that the program is in fact being complied with. Although this may not reduce the risk of being audited, it should help to reduce the risk of a significant repayment obligation. Finally, in the event a provider is subject to a Medicare audit it is important to take the steps necessary to prepare an appropriate response and to be familiar with the steps of the audit process. 

For additional information on the Medicare Recovery Audit Program, please see

Paul J. Welk