CMS Releases Medicaid RAC Q&A

The Centers for Medicare & Medicaid Services (CMS) recently released a Medicaid RAC Q&A that discusses operational guidance to States and general information regarding its Medicaid RAC program. The Affordable Care Act, section 6411(a) expanded the Medicare Recovery Audit Contractor (RAC) program (now Recovery Audit program) to Medicaid and requires each State Medicaid program to establish a RAC program, absent an exception, to enable the auditing of claims for services furnished by Medicaid providers.

These Medicaid RACs must identify overpayments and underpayments. States and their Medicaid RACs must coordinate their recovery audit efforts with other contractors or entities performing audits of entities receiving Medicaid payments, including State and Federal law enforcement with respect to the US Department of Justice (including the Federal Bureau of Investigation [FBI]); HHS, Office of Inspector General; State Medicaid Fraud Control Units (MFCUs), as well as other Federal and State law enforcement agencies, as appropriate. To date, there is no report of Medicaid RAC activity in Virginia.