WASHINGTON, D.C. – Today Congresswoman Lois Capps (D-Santa Barbara) and Congressman Devin Nunes (R-Visalia) introduced legislation that would force the Centers for Medicare and Medicaid Services (CMS) to enact a one year nationwide moratorium on the Recovery Audit Contract (RAC) program. 

“We need to quickly enact this legislation to protect health care providers and patients in California and across the country from this deeply flawed Recovery Audit Contract program,” said Capps.  “Unfortunately CMS has botched this program from the start and it appears to be unwilling or unable to adequately address the serious problems with the program.  CMS has consistently failed to address our concerns with RAC, most recently ignoring our request for written information on their so-called “pause” of the program in California.  CMS clearly isn’t up to the task of fixing this problem, so Congressional intervention is necessary.”

“Due to the failure of CMS to address our concerns, I think Congress has been placed in a position that makes passage of a moratorium likely.  A delay in the Recovery Audit Program (RAC) is necessary because it is essential that medical judgment not be superseded by the views of accountants who earn their income from contingency fees,” said Rep. Nunes.

The legislation would require CMS and the U.S. Government Accountability Office (GAO) to evaluate the RAC program and report to Congress on their findings.   The CMS report would include specific information about the number and types of claims reviewed, the types of reviews, and the outcome of appeals.  The GAO report would examine the RAC program’s compliance with current Medicare policy as well as compare its efficiency with existing Medicare quality improvement programs and contractors.  CMS would also be required to submit quarterly reports to Congress once the RAC program resumes. 

“The California Hospital Association is extraordinarily grateful to Reps. Capps and Nunes for their tireless efforts on behalf of the hospitals and their patients in California that have been faced with the negative impact of the RAC demonstration program.  We appreciate having such dedicated members of the delegation who truly care about the best interests of patients and we urge all members of the CA delegation to join Capps and Nunez in supporting this vital legislation,” said C. Duane Dauner, President and CEO of the California Hospital Association.

In June of this year Congresswoman Capps and Congressman Nunes, along with 34 of their California colleagues, wrote to CMS regarding their concerns with aspects of the RAC program.  This letter was followed-up by a written response from CMS and a meeting with Members of Congress, their staff, and CMS officials on August 1st on Capitol Hill.  Following the meeting CMS promised to work with Members of Congress and health care providers to address their concerns with the RAC program.  Despite these assurances CMS has repeatedly failed to adequately address these concerns, thus necessitating the legislation.

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Pictured above: (center) Congresswoman Capps meets with Central Coast firefighters to discuss emergency preparedness.