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ACA’s Medicaid Audit Program Well-Intended but Highly Flawed, ADA Tells Senate Committee Roundtable

July 11, 2014 ACA’s Medicaid Audit Program Well-Intended but Highly Flawed, ADA Tells Senate Committee Roundtable

The implementation of an Affordable Care Act provision increasing the use of private contractors to demand patient records and conduct audits on providers is having a negative effect on some Medicaid dental programs, Dr. Jessica Meeske told a Senate panel July 9. 

Representing the ADA, Dr. Meeske participated in a roundtable discussion hosted by the Senate Special Committee on Aging at which committee members heard about the problems associated with Medicare and Medicaid Recovery Audit Contractor (RAC) programs. While the ADA supports efforts to rein in fraud in Medicaid, it believes the RAC program as currently operated is seriously flawed.

RAC audits “lack transparency and an opportunity for feedback due largely to a breakdown in communication,” Dr. Meeske said. “I fear that the impact may negatively affect dental services for this population.”

“It is the state Medicaid system that is broken,” she added. “The RAC auditors are chasing the wrong rabbit. It is the system that is broken, not the providers!”

A copy of Dr. Meeske’s roundtable testimony (in the form of a letter) is available. (PDF)

The committee published and released a report on Medicare and Medicaid audits following the roundtable. The report includes the following text: 

The Affordable Care Act also expanded the RAC program to Medicaid and began audit processes in some states in 2012. The American Dental Association (ADA) immediately began to hear concerns from its members and reached out to Members of Congress to call for transparent, fair, consistent and statistically sound audit processes in each state. The ADA’s concerns primarily center around the lack of transparency in the audit process and notification procedures. Additional concerns include the statistical sampling and extrapolation methods used, the qualification of RAC auditors, and the knowledge level of those auditors regarding specific State Medicaid billing regulations.

Further on the report adds:

“The ADA’s primary concern was that the burdensome and opaque nature of the audit process may cause providers to drop out of the Medicaid program, which already struggles to attract and maintain dental professionals willing to provide critical dental services to Medicaid patients.”

The Senate Committee has put a video of the roundtable discussion on its web site. (Dr. Meeske’s testimony begins at the 49:32 mark.)