Today, Rep. George Holding (R-NC) introduced legislation entitled “The Fair Medical Audits Act of 2015.” This legislation reflects years of effort by the North Carolina Medical Society (NCMS) working with Physicians Advocacy Institute (PAI) to address many concerns physicians throughout the country have with the extraordinary lack of transparency and expensive, time-consuming and often unfair processes plaguing the current Medicare audit program.
“Here in North Carolina, I have witnessed firsthand how the current Medicare audit process can destroy a practice,” said Robert W. Seligson, MBA, MA, EVP/CEO of the NCMS and President of PAI. “It is time to address fundamental problems that have contributed to the backlog of audit appeals and caused a great deal of unnecessary expense and confusion for physicians nationwide.  We commend Congressman Holding for his leadership on this critically important issue.”
Learn more:  How the FMAA Will Help Physicians (PDF).
The NCMS has been integrally involved in pushing for this legislation over the years, and looks forward to supporting its passage. To highlight the issue of fairness and transparency in the RAC audit process, the NCMS profiled one practice in New Bern that was devastated by the current system in a documentary titled “Guilty Until Proven Innocent: When Medicare Audits Cause Casualties.” Watch it now.
Currently, Medicare pays recovery audit contractors or “RACs” on a contingency basis to find overpayments to health care providers, providing these contractors with undue monetary incentives to audit doctors. This legislation would establish incentives for RACs to make more accurate audit findings and increase educational efforts to help physicians avoid common mistakes.  Since its inception in 2006, the PAI has been committed to advocating for more fair and transparent medical audits.
“Put simply, patients achieve the best health outcomes when practicing physicians do just that – practice medicine. My bill will bring transparency and fairness to the audit process so doctors can spend more time caring for their patients and less time proving their innocence,” said Rep. Holding. “Medicare frauds must be found and severely punished but not at the cost of the independent practice of medicine.”
Rep. Holding is a member of the House Ways and Means Committee, which has jurisdiction to consider legislation to reform the RAC program.
The NCMS also has been working closely with Sen. Richard Burr (R-NC) on this issue. Thanks to Sen. Burr, former NCMS President Robert Monteiro, MD, testified in March 2014 before a special meeting of key Senate Finance Committee staff hosted by Sen. Orrin Hatch. Dr. Monteiro detailed his practice’s experience with a flawed RAC audit and the financial hardship it caused.  Sen. Burr has been working to address the issues with the current RAC audit system, and hopes to introduce legislation in the near future.
“Unfortunately, one of the most common complaints I hear from North Carolina’s health care community is the need to improve Medicare’s audit and appeals processes,” Burr said. “I will continue working with my constituents and colleagues in Congress, to restore the proper balance to Medicare’s audit and appeals processes on behalf of all North Carolinians.”
Watch the Bulletin for updates on the progress of this legislation.