WASHINGTON, D.C. – In a December 10, 2007 article, The Sacramento Bee reports that Medicare officials recently informed Congress that policy inconsistencies were found in approximately 40 percent of PRG-Schultz International's recovery audit decisions. 

In the article, The Sacramento Bee also reports that Kerry Weems, Acting Administrator of the Centers for Medicare & Medicaid Services (CMS), recently delivered a letter to Capitol Hill indicating that CMS will direct PRG-Schultz International to re-review those cases once the agency's policies are clarified.

In a September 27, 2007 article, The Sacramento Bee previously reported that CMS declared a "pause" in the Medicare recovery audit contractor (RAC) program for the month of October 2007 so that CMS could investigate and resolve any problems with the auditing the inpatient rehabilitation claims of California providers. 

The reported pause in the RAC program was preceded by a May 29, 2007 letter in which U.S. Representatives Lois Capps and Devin Nunes, along with other members of California's Congressional delegation, urged CMS to examine the practices of the RAC auditing California providers after concerns arose about the interpretation and application of Medicare policies and the qualifications of personnel performing claim reviews.

More recently, U.S. Representative Lois Capps introduced the Medicare Recovery Audit Contractor Program Moratorium Act of 2007 (H.R. 4105) on November 7, 2007.  If enacted, H.R. 4105 would generally suspend activities under the Medicare RAC program for a period of 1 year following enactment. H.R. 4105 has been referred to the House Ways and Means and the House Energy and Commerce committees, and currently has 20 cosponsors.

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