If You Liked Medicare RAC, You’ll Love Medicaid RAC’s

If you liked Medicare RAC, you’ll love Medicaid RACs

Washington Report: Capitol Associates
On September 14, 2011, the Department of Health and Human Services (HHS) released its final rule for the new Medicaid Recovery Audit Program. This is part of the Obama Administration’s initiative to curb waste, fraud, and abuse. Authorized by the Patient Protection and Affordable Care Act, the Medicaid Recovery Audit Program is modeled after the Medicare RAC initiative and, like the Medicare RAC, independent auditors will be paid using a contingency fee arrangement whereby monies paid to these contractors will come of out of any improper payments the RAC recovers.
Because the Medicaid program is jointly funded by the states and the federal government, the money left over after the RAC gets its cut, will be split between the federal treasury and the state’s coffers.
Under the new Medicaid program, “RACs can only go three years back from the date the claim was paid, and are required to employ a staff consisting of nurses, therapists, certified coders, and a physician.” Although RACs will have the ability to identify both underpayments as well as overpayments (and receive a bounty for either) the findings of overpayments are expected to far outweigh the findings of underpayments.