Earlier this year, members of the Senate Finance Committee expressed concerned that the functions completed by independent contractors -- known as recovery audit contractors (RACs) and Zone Program Integrity Contractors (PICs) -- often overlap.
They solicited industry feedback for white papers to offer best practices in detecting and coordinating fraud prevention. OK, up until then I had no idea what a PIC was. Among their duties:
- Prevents fraud by identifying program vulnerabilities.
- Proactively identifies incidents of potential fraud that exist within its service area and takes appropriate action on each case.
- Investigates (determines the factual basis of) allegations of fraud made by beneficiaries, providers, CMS, OIG, and other sources.
- Explores all available sources of fraud leads in its jurisdiction, including the MFCU and its corporate anti-fraud unit.
And there is more of course. Suffice to say RACs and PICs are tasked with fraud detection. I think the nuance is that PICs have a broader responsibility whereas RACs specifically review claims.
Medicare and Medicaid programs lose between $20 billion and $100 billion to fraud and payment errors, according to an open letter issued by a bipartisan group of six committee members. The letter asked all types of stakeholders, from providers to patients, to submit detailed proposals detailing ways to strengthen program integrity. RACs have been credited with identifying $1.2 billion in improper payments in fiscal 2011.
Bottom line - whether it is a RAC or a PIC, protect yourself. Transparency in healthcare will continue to grow. And if you are pursuing the right path, well you have nothing to worry about.
Learn more ~ or join the conversation!
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