Maria Perrin, HMS’s Chief Business Officer, was quoted in an article about the Medicaid Recovery Audit Contractor (RAC) program that was published in a recent edition of the Bloomberg Health Care Fraud Report.

The article, “Stakeholders’ First-Year Score Card: Medicaid RAC Program Gets Mixed Reviews,” looks at the impact the Medicaid RAC program had on states and providers during its first full year of operation. According to the article, most experts agree that it’s too early to judge the overall success of the program; however, they suggest that some changes may be needed to ensure the effectiveness of Medicaid RAC audits going forward, including:

• Encouraging oversight of managed care claims as Medicaid agencies move away from the fee-for-service model,
• Improving coordination between existing auditors and Medicaid RAC contractors to avoid overlap, and
• Addressing the current requirement that Medicaid RAC vendors in all 50 states employ a medical director—an expense that some states have found to be unnecessary.

Perrin notes that of the 25 states in which HMS currently acts as the Medicaid RAC, those that have performed RAC-like work before are already achieving success with the program, while those without Medicaid RAC experience have been slower to start, due in part to a lack of appropriate legislation in their states. She encourages CMS to give states more freedom to tailor their Medicaid RAC programs to suit their specific needs rather than rely on a “one size fits all” approach.

Perrin also addresses providers’ initial negative reaction to the creation of the Medicaid RAC program, stating that contractors should make the audit process as transparent as possible while offering ample resources and education in order to minimize provider pushback.

Experts expect to be able to assess the financial success of the Medicaid RAC program between early 2013 and 2014.

Click here to read the article.