RACs Program Expanding to Medicaid in 2012

The Recovery Audit Contractor (RAC) program, a key initiative in the federal government’s push to crack down on Medicare fraud, waste and abuse since 2009, is being expanded to the Medicaid program as of January 1, 2012.


The Centers for Medicare & Medicaid Services (CMS) in mid-September released a final rule detailing regulations and implementation rules for the Medicaid RAC. According to a recent article in amednews.com, the new program – with several revisions -- will mirror the existing Medicare RAC initiative. Auditors contracting with the states’ Medicaid programs will be compensated based on a percentage of funds they recover that have been paid inappropriately to physicians, hospitals and other providers and suppliers.


Program changes include the stipulation that each Medicaid RAC be required to hire a physician as a medical director to review medical claims. Additionally, the Medicaid RACs are limited in age of claims that can be requested for review. The frequency of requests also is constrained.


The Department of Health and Human Services (HHS) expects the Medicaid RAC program could save $2.1 billion over the next five years.


To view the complete amednews.com story, visit:http://www.ama-assn.org/amednews/2011/09/26/gvl10926.htm


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