RAC audit defense

Attorneys experienced in RAC audit defense can ensure that a healthcare provider’s rights are protected while also guiding the provider through a successful audit process. The Centers for Medicare/Medicaid Services (CMS) utilize the services of Recovery Audit Contractors (RACs) to detect and correct overpayments resulting from non-compliant medical claims submitted by physicians and other healthcare providers. In a 3-year time span, RACs have identified and modified more than $1.03 billion in payments to healthcare providers. Almost 100% of this amount were funds collected from providers for overpayments.

RAC audit defense counsel is an essential asset once a healthcare provider has been informed that they will be subject to a RAC audit. In a report titled Doctors, health care executives accused of Medicare fraud published by CNN on June 24, 2009, one can establish that the Obama Administration is devoted to effectively identifying Medicare fraud, recovering those funds, and reducing fraud that effects the American taxpayer. The majority of healthcare providers are consistently adhering to the ever-changing documentation requirements set by the CMS. However, some have submitted non-compliant medical claims which result in improper payments. An attorney experienced with RAC audit defense can articulate the pearls of proper documentation that will reduce the chances of an RAC audit. In the Medicare Prescription Drug, Improvement, and Modernization Act of 2003, Congress authorized CMS to pay RACs on a contingency basis. This entitles RACs to a percentage of the monies that they identify and recover from improper medical claims. Incentivizing RACs to identify as many possible improper payments naturally increases the likelihood that a healthcare provider will be audited.

An RAC audit defense attorney can advise a healthcare provider as to the proper steps to take from the outset of the audit process. It is essential for a healthcare provider to comply with every request from the RAC. Non-compliance with requests may have negative financial and/or legal consequences. Ensure that you are knowledgeable about CMS’s current documentation requirements. Equally important is to be knowledgeable about your rights. An RAC audit defense attorney is ready to provide you with the proper information to do this.


April 26th, 2011