In letters to Secretary of Health and Human Services, Kathleen Sebelius, U.S. Congressman Dave Camp, Chairman of the House Ways and Means Committee, and U.S. Congressman Fred Upton, Chairman of the House Energy and Commerce Committee, U.S. Congressman Dan Boren urged the examination of the methods imposed by Connolly, Inc., and other Centers for Medicare and Medicaid Services (CMS) Recovery Audit Contractors (RACs).
The recovery audit process can cause a serious destabilizing financial effect on a rural hospital's ability to continue operations. RACs are permitted to review three previous years of Medicare and Medicaid payments and reconcile them in the current fiscal year. While providers have the opportunity to appeal, rural providers are at a disadvantage due to limited staffing capacity that can be dedicated to the cumbersome review process. In addition to the review, the appeals process also consumes a substantial amount of the limited resources available to rural providers. If the RACs determination is upheld, hospitals are not only accountable for repaying the questioned debt, but also any interest that has accrued.
Connolly, Inc. and other RACs are causing significant survival choices for rural hospitals by impacting operational cash flow, cash reserves, and any other publicly approved support in the form of city or county taxes. As part of their collection efforts, Connolly, Inc. is entitled to retain approximately one third of the recovered "overpayments" to providers. RACs have the ability to completely dismantle healthcare facilities because there is no cap placed on the total amount the auditors can seize. In the wake of a sluggish economy, Connolly Inc. is adding to the tremendous burden that rural communities in Oklahoma are already experiencing.
"While I fully support the need to protect taxpayer money and prevent wasteful government spending, I disagree with the extreme practices under which Connolly, Inc. operates and the exorbitant fees it is permitted to collect. Connolly, Inc. has engaged in what can only be described as overzealous predatory tactics against several of my constituent hospitals with their aggressive, overly critical approach," said Boren. "These practices have the potential to create a life-threatening situation for patient care in impoverished rural communities of Oklahoma. Connolly Inc. cannot be allowed to balance the CMS budget on the back of Oklahoma's rural healthcare providers, which have limited ability to fight this extreme and abusive harvest of Medicare funds. I urge policy-makers to closely examine the debilitating practices imposed by Connolly, Inc. and other RACs and consider placing a moratorium on the amount of funds recouped from rural hospitals."
The Recovery Audit program is an effort aimed at reducing improper payments within Medicare programs, deriving authority for collection as mandated by the Tax Relief and Health Care Act of 2006. Connolly is the exclusive RAC for region C, which includes the Second District of Oklahoma.