MEDICARE RECOVERY AUDIT CONTRACTORS AND CMS’S ACTIONS TO ADDRESS IMPROPER PAYMENTS, REFERRALS OF POTENTIAL FRAUD, AND PERFORMANCE

Department of Health and Human Services: 8/29/13

WHY WE DID THIS STUDY 

Recovery Audit Contractors (RAC) are designed to protect Medicare by identifying improper payments and referring potential fraud to the Centers for Medicare & Medicaid Services (CMS). Prior Government Accountability Office work has identified problems with CMS’s actions to address improper payment vulnerabilities, and prior Office of Inspector General (OIG) work has identified problems with CMS’s actions to address referrals of potential fraud. Further, OIG has identified vulnerabilities in CMS’s oversight of its contractors. Given the critical role of identifying improper payments, effective oversight of RAC performance is important.  Read More