State Audits Could Recover Waste from Medicare Medicaid Payments

By Seattle Business Magazine March 15, 2011

Washington, in what is hardly a unique situation, is in the midst of a budget crisis. Right now, Washingtons 1.1-million Medicaid enrollees and their healthcare providers face up to $112.9 million in cuts to the states Medicaid budget. Enrollment in the Basic Health program is expected to be trimmed by 17,000 people, and its anticipated that 1,300 children will be dropped from the states Childrens Health Program.

In an effort to alleviate these staggering budget shortfalls, the Centers for Medicare and Medicaid Services (CMS) and state Medicaid departments nationwide are contracting with Recovery Audit Contractors (RACs), companies that specialize in identifying and recovering millions of dollars are lost to states each year through overpayments to providers due to errors in diagnoses, billing and beyond. This means that millions of dollars in funds that could otherwise offset Washingtons healthcare deficit, and are currently wasted through these payment errors, could be returned to the states Medicaid coffers.

PRGX Global, Inc. (https://www.prgx.com/audit/healthcare-claims-improper-payment-audit/medicaid-recovery-audits/) specializes in identifying and recovering improper payments to state budgets. As part of national health reform legislation and CMS requirement that every state establish contracts with recovery audit contractors, PRGX anticipates that states, including Washington, could recover anywhere from .1% to .5% of Medicaid spend per state, depending on variables.

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