Study to Show Medicare Could Save Money by Fairer Handling of Enormous Backlog of More Than One Million Audit Appeals
Massive Overhang of Appeals Has Already Shuttered Over 100 Health-Related Businesses in the U.S.; Study Identifies More Than $10 Million in Possible Medicare Savings From Better Handling.
WASHINGTON, March 18, 2015 /PRNewswire-USNewswire/ -- //NEWS ADVISORY// A hidden crisis for small businesses that provide health care services – such as orthotics and prosthetics – has already shut down more than 100 firms nationwide and threatens the existence of many more as a result of a massive backlog of more than one million Medicare audit appeals that have languished for years … and with no resolution in sight.
The good news is that a new Dobson l DaVanzo study commissioned by the American Orthotic & Prosthetic Association (AOPA) will show that Medicare could avoid forcing the shutdown of more businesses and also save over $10 million by taking common-sense steps until the Medicare audit appeals mess is resolved.
The new study will be released at 1:30 p.m. EDT Thursday (March 19, 2015) during a phone-based news event. News event speakers will be:
- Charles Dankmeyer, president, American Orthotic & Prosthetic Association.
- Study co-author Allen Dobson, president, Dobson | DaVanzo.
- Study co-author Audrey El-Gamil, senior manager, Dobson | DaVanzo.
- Mary Palmer, business manager, Nelson Prosthetic and Orthotic Laboratory, a Buffalo, New York firm that has been forced to lay off employees in the wake of dozens of audits.
TO PARTICIPATE: You can join this live, phone-based news conference (with full, two-way Q&A) at 1:30 p.m. EDT on March 19, 2015 by dialing 1 (877) 418-4267. Ask for the "AOPA Audit Abuse" news event.
CAN'T PARTICIPATE?: A streaming audio recording of the news event will be available on the Web as of 5 p.m. EDT on March 19, 2015 at www.aopanet.org.
ABOUT AOPA
The American Orthotic & Prosthetic Association is a national trade association committed to providing high quality, unprecedented business services and products to O&P professionals. Since our founding in 1917, we have worked diligently to establish ourselves as the voice for O&P businesses. Through government relations efforts, AOPA works to raise awareness of the profession and impact policies that affect the future of the O&P industry. AOPA membership consists of more than 2,000 O&P patient care facilities and suppliers that manufacture, distribute, design, fabricate, fit, and supervise the use of orthoses (orthopedic braces) and prostheses (artificial limbs). Membership in AOPA represents a professional milestone; it is recognition of leadership and achievement in the O&P community.
BACKGROUND
Legitimate Medicare audits are a necessary part of the federal government discharging its responsibility to protect federal moneys and to fight fraud and abuse. However, the current Recovery Audit Contractor (RAC) Program system has some flaws, starting with the fact that RAC auditors are incentivized to maximize their assertions of provider errors by virtue of the RACs being compensated via a "bounty" of up to 13 percent for every dollar clawed back, before the provider exhausts their appeal rights. The Medicare statute promises that appeals will go to an independent administrative law judge (ALJ) and that a decision will be forthcoming within 90 days of a hearing request.
But the reality is nowhere close to that. The number of audits each year has exploded exponentially— 10 or more times what took place just a few years ago. Providers must repay Medicare amounts contested by the RAC auditors before any independent appeal, and Medicare holds the money unless and until the provider wins it back at the ALJ level. In turn, the number of requests from providers for ALJ hearings has mushroomed even more massively than the 10-fold increase in RACs. Decisions that the law promises will occur in 90 days may take 4 years -- as Medicare holds the money, albeit with the promise to pay above market interest if the provider wins. For small health-related businesses, this seemingly unending audit process and financial uncertainty can prove to be fatal.
SOURCE The American Orthotic & Prosthetic Association
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