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Recovery Audit Contractors (RAC), Fraud Referrals, Recommendations

The Office of Inspector General (OIG) released a report discussing some of its recent findings regarding the Recovery Audit Contractor (RAC) 3-year demonstration program. The report revealed that between March 2005 and March 2008, the RACs “referred two cases of potential fraud to the Centers for Medicare & Medicaid Services (CMS). However, CMS reported that it received no potential fraud referrals from RACs during this period.” The OIG learned that the RACs were not properly trained in detecting fraud and recommended to CMS that it do the following: “(1) conduct followup to determine the outcomes of the two referrals made during the demonstration project, (2) implement a system to track fraud referrals, and (3) require RACs to receive mandatory training on the identification and referral of fraud.” CMS has accepted and agreed and has already begun to adopt these recommendations.

For more information, please contact Abby Pendleton, Esq. or Jessica L. Gustafson, Esq. at (248) 886-8510, visit our RAC specialty page, or the HLP website.

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