"Lab Compliance Update"

CLMA Asks Labs for Examples of RAC Auditor Overreach

Senate Finance Committee tasked GAO to study Medicare program’s audits of healthcare providers

STORIES ABOUT HOW PRIVATE MEDICARE AUDITORS are overreaching in their zeal to identify fraud have caught the attention of the U.S. Senate Finance Committee. It is asking providers to submit examples of overzealous RAC auditors.

For its part, the Clinical Laboratory Management Association (CLMA) is collecting examples of recovery audit contractor (RAC) auditors behaving badly when they audit clinical laboratories. CLMA will send the examples to the Finance Committee, said CLMA President Rodney W. Forsman.

Forsman, who is also Assistant Professor Emeritus of Laboratory Medicine and Pathology in the College of Medicine at the Mayo Clinic, explained that CLMA has sent a memo to its members requesting such examples. CLMA will forward them to the U.S. Senate Finance Committee.

Examples of Audit Problems

In this memo to members, CLMA said it is seeking examples of: a) poor or unclear writing; b) requests based on inaccurate information; c) typographical errors; d) burdensome requests for information, such as asking for hundreds of records; e) a lack of coordination by contractors, such as when one auditor asks for the same documentation from various sources within a lab; f) a failure to follow proper procedures or current rules; and, g) other examples labs may wish to report.

“The Senate Finance Committee also asked the Government Accountability Office (GAO) to study the audits being conducted in the Medicare program,” he added. “The committee has heard a variety of complaints about auditors who work for one of several Medicare auditing programs. CLMA wants to confirm what is so far only hearsay. Hearing a number of stories second hand is not the same as having the providers involved explain the circumstances in their own words.

Are Auditors Inconsistent?

“We heard, for example, that a RAC auditor may be inconsistent in how it cites different laboratories for a violation,” he continued. “In one case, if the auditor finds that payment for a certain type of lab test was denied, it may cite another lab for receiving a payment for that same type of lab test. But how is receiving that payment from a Medicare carrier evidence of fraud on the lab’s part?

“In this example, if the Medicare carrier has applied the rules inconsistently, then the RAC contractor should address that question to the Medicare carrier and not to the lab itself,” noted Forsman. “Labs and other providers are invited to share these types of experiences so the Senate committee has real world examples of audits that were poorly conducted.”

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