Recovery Audit Contractor
Encyclopedia
The Recovery Audit Contractor, or RAC, program was created through the Medicare Modernization Act of 2003 (MMA) to identify and recover improper Medicare
payments paid to healthcare providers under fee-for-service
(FFS) Medicare plans. The United States Department of Health and Human Services
(DHHS) is required by law to make the program permanent for all states by January 1, 2010 under section 302 of the Tax Relief and Health Care Act of 2006
.
directed the DHHS to conduct a three-year demonstration program to detect and correct improper payments in the Medicare FFS program. DHHS, through its Centers for Medicare and Medicaid Services
(CMS) branch, began the program in 2005, using Recovery Audit Contractors to perform the actual work of reviewing, auditing, and identifying improper Medicare payments. At the inception of the program, it focused on Medicare payments in the states of California, New York, and Florida. The program eventually expanded to Massachusetts and South Carolina before ending in March 2007. By the end of the demonstration, the program had recovered nearly $693.6M on behalf of CMS.
region B, Connolly, Inc
region C, and HealthDataInsights region D. Each RAC may subcontract portions of its region. PRG Shultz subcontracts for portions of regions A, B and D. iHealth Technologies and Strategic Health Solutions are also subcontractors for region A, while Viant is a subcontractor for region C.
Medicare (United States)
Medicare is a social insurance program administered by the United States government, providing health insurance coverage to people who are aged 65 and over; to those who are under 65 and are permanently physically disabled or who have a congenital physical disability; or to those who meet other...
payments paid to healthcare providers under fee-for-service
Fee-for-service
Fee-for-service is a payment model where services are unbundled and paid for separately. In health care, it gives an incentive for physicians to provide more treatments because payment is dependent on the quantity of care, rather than quality of care...
(FFS) Medicare plans. The United States Department of Health and Human Services
United States Department of Health and Human Services
The United States Department of Health and Human Services is a Cabinet department of the United States government with the goal of protecting the health of all Americans and providing essential human services. Its motto is "Improving the health, safety, and well-being of America"...
(DHHS) is required by law to make the program permanent for all states by January 1, 2010 under section 302 of the Tax Relief and Health Care Act of 2006
Tax Relief and Health Care Act of 2006
The Tax Relief and Health Care Act of 2006 , includes a package of tax extenders, provisions affecting health savings accounts and other provisions in the United States.-Extenders:...
.
History
In section 306 of the Medicare Modernization Act of 2003, the United States CongressUnited States Congress
The United States Congress is the bicameral legislature of the federal government of the United States, consisting of the Senate and the House of Representatives. The Congress meets in the United States Capitol in Washington, D.C....
directed the DHHS to conduct a three-year demonstration program to detect and correct improper payments in the Medicare FFS program. DHHS, through its Centers for Medicare and Medicaid Services
Centers for Medicare and Medicaid Services
The Centers for Medicare & Medicaid Services , previously known as the Health Care Financing Administration , is a federal agency within the United States Department of Health and Human Services that administers the Medicare program and works in partnership with state governments to administer...
(CMS) branch, began the program in 2005, using Recovery Audit Contractors to perform the actual work of reviewing, auditing, and identifying improper Medicare payments. At the inception of the program, it focused on Medicare payments in the states of California, New York, and Florida. The program eventually expanded to Massachusetts and South Carolina before ending in March 2007. By the end of the demonstration, the program had recovered nearly $693.6M on behalf of CMS.
Jurisdictions
The RAC program divides the United States into four jurisdictions (regions A through D), each comprising approximately one quarter of the country, and contracts are awarded for each region. Diversified Collection Services audits region A, CGI GroupCGI Group
CGI Group Inc. is an information technology management and business process services company. Founded in 1976 and headquartered in Montreal, Canada, CGI employs approximately 31,000 professionals in over 125 offices in 16 countries. As of September 2010, CGI had an annual revenue of CA $3.7...
region B, Connolly, Inc
Connolly, Inc
Connolly, Inc. is a private, global recovery audit firm with more than 750 employees headquartered in Atlanta Georgia. The firm’s marketing, IT, finance, and HR functions, as well as its main data center, are located in Wilton, CT...
region C, and HealthDataInsights region D. Each RAC may subcontract portions of its region. PRG Shultz subcontracts for portions of regions A, B and D. iHealth Technologies and Strategic Health Solutions are also subcontractors for region A, while Viant is a subcontractor for region C.