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Government Accountability Office’s Review of the Recovery Audit Contractor Program

Government Accountability Office’s Review of the Recovery Audit Contractor Program. Presentation by: Kathleen M. King, Director, Health Care Government Accountability Office National Medicare RAC Summit Washington, D.C. March 6, 2009. Who We Are.

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Government Accountability Office’s Review of the Recovery Audit Contractor Program

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  1. Government Accountability Office’sReview of the Recovery Audit Contractor Program Presentation by: Kathleen M. King, Director, Health Care Government Accountability Office National Medicare RAC Summit Washington, D.C. March 6, 2009

  2. Who We Are • GAO is an independent, nonpartisan agency that advises Congress about ways to make government more efficient, effective, ethical, equitable, and responsive. • GAO’s mission is to support the Congress in meeting its constitutional responsibilities and to help improve the performance and ensure the accountability of the federal government for the benefit of the American people.

  3. Who We Are (cont.) • GAO’s core values are accountability, integrity, and reliability. • GAO’s work is done at the request of congressional committees or subcommittees or is mandated by public laws or committee reports.

  4. Background – Request for RAC Study • Five members of Congress requested that GAO undertake a study of the RAC program and make recommendations for its continued improvement. • Four requesters were the chairs of the Committees on Energy and Commerce and Ways and Means and their respective Subcommittees on Health; one requester was Rep. Lois Capps from California.

  5. National RAC Program and Bid Protest • CMS conducted a competition to select contractors for the national program. • Two companies whose bids were not selected protested the award in November 2008. • The bid protest was resolved in February 2009. • CMS plans to begin implementing the national program on March 1, 2009.

  6. Objectives • Our study, which began in December 2008, focuses on steps CMS has taken to assure a smooth rollout of the national program. • Estimated release not yet determined.

  7. Objectives (cont.) What actions is CMS taking to: • Prevent future improper payment in areas identified by the RACs; • Assure effective coordination among the RACs, Medicare Administrative Contractors, and Zone Program Integrity Contractors; and • Oversee RAC auditing efforts.

  8. Scope and Methodology GAO will conduct a series of interviews with: • CMS officials responsible for oversight of the program • Contractors responsible for various aspects of the RAC program • Provider groups and associations • Other stakeholders

  9. Scope and Methodology (cont.) GAO will also review relevant agency documents, including: • RAC Demonstration Evaluation Report • Statement of Work • Revisions to the Program Integrity Manual

  10. GAO Reports GAO reports are available to the public at: http://www.gao.gov/ Questions: Kathleen M. King Director, Health Care, Government Accountability Office 441 G Street NW, Washington, D.C. 20548 202-512-7114, Email: kingk@gao.gov

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