News: CMS to expand oversight program

The Centers for Medicare & Medicaid Services will expand its six-state Recovery Audit Contractor program to all 50 states by the end of 2009, CMS announced in October. Charged with investigating Medicare overpayments and underpayments to doctors and hospitals, RAC will expand this month to include Arizona, Colorado, Florida, Indiana, Maine, Massachusetts, Michigan, Minnesota, Montana, New Hampshire, New Mexico, New York, North Dakota, Rhode Island, South Carolina, South Dakota, Utah, Vermont, and Wyoming.

The central focus of the audits is abuse and fraud in medical referrals and sales of durable medical equipment, according to Judy Bee of Practice Performance Group in La Jolla, California. "Most primary care physicians do not provide DME," she says. "It sounds like [the CMS is] looking into the commercial ventures that advertise on TV and also for referrals to companies in which a physician is an investor."