Percentage of Improper Payments Made Under the Medicare Fee-for-Service Program
CHAPTER 5: Conclusion
This case study is a qualitative analysis of the termination of the Recovery Audit Contracting program. As such, it has particular limitations. The RAC program is one instance of a watchdog program, so the presented characteristics of watchdog programs may not apply to every program. Also, the conclusions of this study may not be generalizable to every government program or watchdog program. Another limitation is the lack of impartial, credible evaluations of the RAC program from 2014 and 2015. While all case studies have limitations, the RAC program case study may be used in several ways.
The RAC case study exposes several major issues in our government. First, I argue watchdog programs developed to ensure accountability and protect the public interest are inherently more likely to be terminated than other government
programs. In fact, functional watchdog initiatives are likely to have shorter lifespans than inefficient or outdated government programs. Watchdog organizations that
may be used in the development of future watchdog organizations to increase the factors for longevity and avoid termination factors in an effort to increase the program’s lifespan.
The single most impactful factor in the termination of the RAC program was lack of support from outside entities. This shows the power interest groups have over government programs. The medical industry is one of the nation’s largest industries. When hospitals faced the administrative burden of claim audits and were forced to repay the government excess received funds, the AHA poured millions of dollars into lobbying efforts to stop the program. Despite the RAC’s positive impact on the lifespan of Medicare and Medicaid, the private sector was able to effectively terminate the program. This shows the power of big business to
influence not just policy, but the direction of such important programs as Medicare and Medicaid.
APPENDICES
APPENDIX A
Source: Council for Medicare Integrity (www.properpayments.org)
APPENDIX B
Source: Council for Medicare Integrity (www.properpayments.org)
APPENDIX C
Source: 2013 GAO report to Congress entitled Medicare Program Integrity
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