Conduct reviews with Recovery Auditor denials in mind

by Trey La Charité, MD

Reducing mistakes and eliminating fraud are the dual goals in today's claims auditing environment. While these goals are admirable, the aggressive strategy typically executed by Recovery Auditors and other auditing agencies to achieve those goals is fundamentally flawed.

The reality is that our healthcare facilities are subjected to a myriad of "Recovery Raiders" that scrutinize everything--from how many units of a drug were billed to whether or not a patient actually needed to be admitted to the hospital. Whether contracted by the federal or state government or employed by the private insurance companies, these entities lack appropriate oversight and accountability.