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First it was Medicare recovery audits - now Medicaid has audits
e-Reports, Oct. 24, 2011
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The federal government has released final rules for the Medicaid Recovery Audit Contractor (RAC) Program, a waste-cutting initiative created by the Affordable Care Act. The program, based on the existing Medicare RAC program, is projected to save $2.1 billion over the next five years, of which $900 million will be returned to states.

In announcing the initiative, Department of Health and Human Services Secretary Kathleen Sebelius said,” We simply can’t afford to see even one penny of our health care dollars wasted and expanding this program will help us reach that goal.”

The Indiana Office of Medicaid Policy and Planning (OMPP) has contracted with Thomson Reuters Health-care to provide an enhanced Fraud and Abuse Detection System. However, Thomson Reuters will subcontract with an independent recovery audit contractor, similar to the RAC program in Medicare.

The Medicaid RAC will audit payments made to health care providers to identify underpayments or overpayments, and then recover overpayment dollars or correct underpayments. At the last ISMA Medicare/Medicaid Coalition meeting, MHS advised that Health Care Insight will conduct system edits on MHS claims in the fall but provided no exact dates.

OMPP encourages you to perform ongoing self-review to ensure compliance with Medicaid payment guidelines. If you discover any potential overpayments during your self-review, notify the OMPP through Indiana Medicaid’s provider self-disclosure process.

See the IHCP Bulletin here.

Find the final rule on Medicaid RAC on the Federal Register website.

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