11.23.09 – Senate Health Care Reform Bill Provides for Recovery Audit Contractor Expansion
The Patient Protection and Affordable Care Act (also known as the Senate’s health insurance reform bill) represents the biggest change to ensure affordable health care to more than 30 millions of Americans. In Section 6411 of the Patient Protection and Affordable Care Act, the bill provides for the expansion of the Recovery Audit Contractor (RAC) program.
Specifically, Section 6411 provides for the Medicare RAC program to be expanded to Medicare Parts C and D by no later than December 31, 2010. For instance, Section 6411 would require the Secretary of the Department of Health and Human Services (Secretary) to ensure that Medicare RAC contracts require RACs to:
- Ensure that each Medicare Advantage plan has an anti-fraud plan in effect and review the effectiveness of the plan;
- Ensure that each Medicare Part D prescription drug plan has an anti-fraud plan and review the effectiveness of the plan;
- Examine claims for reinsurance payments to determine whether prescription drug plans incurred costs in excess of the allowable reinsurance costs permitted; and
- Review estimates submitted by prescription drug plans (by private plans) with respect to the enrollment of high cost beneficiaries and compare such estimates with the numbers of such beneficiaries actually enrolled in the plans.
In addition, Section 6411 would also establish a RAC program for the Medicaid program. Based on Section 6411, it appears that a Medicaid RAC program would be similar to the current Medicare RAC program. That is, Medicaid RACs would be charged with looking for overpayments (and underpayments) and recovering the overpayments. In addition, Medicaid RACs would be paid on a contingent basis from the overpayment amounts recovered.
For more information, see Section 6411 of the Patient Protection and Affordable Care Act.
