Medicaid RAC Activity by State

Alabama

  • SPA submitted 12/21/2010
  • SPA approved 2/24/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state converted existing contracts with HMS and Ingenix Public Sector Solutions, Inc. to act as the Medicaid RACs
  • In October 2012, the state issued an RFP for Medicaid Recovery Audit Contractor Services, with a proposal response date of 10/22/2012
  • In November 2012, the state issued an intent to award notice to Goold Health Systems, with a contract start date of 1/1/2013. The final award was subject to review by the Legislative Oversight Committee, approval by CMS, and signature by the Governor.


Alaska

  • SPA submitted 12/21/2010
  • SPA approved 2/24/2011
  • The state is seeking exemptions from RAC audit scope
  • In May 2012, the state issued a joint RFP for RAC services with the Medicaid programs in Idaho, Montana, and Utah
  • In June 2012, the state announced that the multi-state RAC contract was awarded to HMS; no other vendors submitted proposals


American Samoa

  • SPA Submitted 12/8/2010
  • SPA Approved 2/10/2010
  • Exceptions sought


Arizona

  • SPA Submitted 12/21/2010
  • SPA Approved 3/11/2011
  • The state is seeking exemptions from RAC audit scope
  • The Arizona Medicaid program is a participant in a state-wide contract with Recovery Audit Specialists (RAS), which provides services that include detection, confirmation, and collection of overpayments. RAS will report audit findings at regularly agreed upon intervals and recommend corrective action. At the current time, the state-wide contract with RAS does not address identification of underpayments, however the state will be working to address the inclusion of activities related to underpayments in the future.
  • The state has designated Recovery Audit Specialists, LLC as its RAC contractor through its existing state-wide cost recovery contract (December 2010)
  • On 3/4/2013, the state issued an RFP for both RAC and Third Party Liability services; proposals were due 4/15/2013
  • In July 2013, the state awarded a contract to HMS to perform RAC services


Arkansas

  • SPA Submitted 1/5/2011
  • SPA Approved 2/25/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued in April 2011. The Arkansas Department of Human Services/Division of Medical Services declined to enter into a contract as a result of the RFP.
  • A subsequent RAC RFP was issued in June 2012, with responses due the following month
  • In August 2012, the state announced its anticipation to award the RAC contract to HMS; a subsequent contract was executed in November 2012
  • Due to state legislation prohibiting contingency fee contracts on state Medicaid recovery audit contracts, the state opted not to pursue implementation of the RAC contract


California

  • SPA Submitted 12/16/2010
  • SPA Approved 2/18/2011
  • The state is not seeking any exemptions from RAC audit scope
  • An RFP for Medicaid RAC services was issued in October 2011, with a proposal due date in December 2011. The due date was subsequently extended to January 2012.
  • In March 2012, the state announced its intent to award the Medicaid RAC contract to HMS; the contract was effective as of April 2013.

 



Colorado

  • SPA Submitted 12/23/2010
  • SPA Approved 3/8/2011
  • A RAC RFP was issued in January 2011
  • RAC scope includes pre-payment fraud, waste and abuse efforts not limited to credit balance audits, incorrect billing and processing errors, and lack of medical necessity. Post payment RAC work includes data mining, medical records review, identifying overpayments
  • The state is not seeking any exemptions from RAC audit scope but wants RAC contractors to work with their existing MMIS vendor.
  • The RAC contract has been awarded to CGI with HMS as a subcontractor
  • In May 2013, the state announced its option not to exercise a contract renewal option for the state fiscal period June 30, 2013 through June 30, 2014, and it is coordinating with its vendor to complete work already in process.


Connecticut

  • SPA Submitted 12/30/2010
  • SPA Approved 3/21/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state has designated HMS as its RAC contractor through an existing contract (June 2011)


Delaware

  • SPA Submitted 12/8/2010
  • SPA Approved 3/4/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued February 4, 2011 with a March 21, 2011 deadline
  • RAC scope includes expanding current and ongoing Medicaid claims review and auditing processes that include high risk areas such as Dental Services, Hospice, Pharmacy, Outpatient Hospital Services, Nursing Homes, Physical Therapy/Occupational Therapy, Durable Medical Equipment, and Home Health Services.
  • The RAC contract has been awarded to HMS


District of Columbia

  • SPA Submitted 3/24/2011
  • SPA Approved
  • The District is not seeking any exemptions from RAC audit scope
  • The District issued a Task Order Proposal Request for a Recovery Audit Contractor in March 2012, with responses due in April 2012
  • In November 2012, the District awarded the RAC contract to PRGX USA, Inc.


Florida

  • SPA Submitted 12/2/2010
  • SPA Approved 1/26/2011
  • The state is not seeking any exemptions from RAC audit scope
  • In March 2012, CMS approved a time-limited exception to implement a RAC contract


Georgia

  • SPA Submitted 12/28/2010
  • SPA Approved 3/28/2011
  • The state is seeking exemptions from RAC audit scope
  • The state has converted an existing contract with contractor Myers & Stauffer LC to perform RAC services


GY

  • SPA Submitted 12/29/2010
  • SPA Approved 2/10/2011
  • Exceptions sought


Hawaii

  • SPA Submitted 12/30/2010
  • SPA Approved 2/10/2010
  • The state is not seeking any exemptions from RAC audit scope
  • In June 2012, the state solicited statements of qualifications and expressions of interest to “implement a Recovery Audit Contractors (RAC) Program to audit claims for services furnished by Medicaid providers,” among other services


Idaho

  • SPA Submitted 12/23/2010
  • SPA Approved 2/18/2011
  • The state is not seeking any exemptions from RAC audit scope
  • Idaho received a waiver from CMS to join MT, WY, and UT in issuing a combined Medicaid RAC RFP
  • In May 2012, the state issued a joint RFP for RAC services with the Medicaid programs in Alaska, Montana, and Utah
  • In June 2012, the state announced that the multi-state RAC contract was awarded to HMS; no other vendors submitted proposals


Illinois

  • SPA Submitted 12/30/2010
  • SPA Approved 3/8/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state issued an RFP for RAC services in April 2012 with responses due in May 2012
  • In October 2012, the state announced its intent to award a contract to HMS to provide payment recapture audits of Medicaid providers; a subsequent contract was executed in December 2012


Indiana

  • SPA Submitted 12/17/2010
  • SPA Approved 2/16/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued in August 2010 as part of the state’s Fraud and Abuse Detection System (FADS). The RAC scope within the FADS RFP includes performing credit balance audits and data analysis to identify claims and providers to target.
  • The FADS contract was awarded to Thomson Reuters with HMS as the subcontractor responsible for all RAC work (October 2010)


Iowa

  • SPA Submitted 1/5/2011
  • SPA Approved 2/22/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state converted an existing contract with Optum Public Sector Solutions, Inc. (OptumInsight) to act as the Medicaid RAC


Kansas

  • SPA Submitted 12/21/2011
  • SPA Approved 2/10/2011
  • A RAC RFP was issued by Kansas in September 2010; scope includes Clinical and Financial Audits for all claim types on a retrospective basis. RACs will also audit the State Benefit Plan
  • The state is seeking exceptions from its RAC audit scope
  • The RAC contract was awarded to HealthDataInsights (HDI)


Kentucky

  • SPA Submitted 12/2/2010
  • SPA Approved 2/28/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state converted an existing contract with Ingenix Inc. to act as the Medicaid RAC


Louisiana

  • SPA Submitted 12/20/2010
  • SPA Approved
  • The state is not seeking any exemptions from RAC audit scope
  • Louisiana released a Request for Information (RFI) for a Medicaid RAC for post-payment identification and recovery of improper Medicaid claims
  • The state has converted an existing contract with Myers & Stauffer LC to perform RAC-related services (January 2013)


Maine

  • SPA Submitted 12/21/2010
  • SPA Approved 3/8/2011
  • A RAC RFP was issued in December 2010; the RAC scope includes both over- and underpayment identification. Audit findings (and supporting documentation from providers) must be presented first to the state; once validated, the state pursues recovery.
  • The state has awarded the RAC contract to HMS
  • The state is not seeking any exemptions from RAC audit scope


Maryland

  • SPA Submitted 12/27/2010
  • SPA Approved 3/24/2011
  • The state is seeking exemptions from RAC audit scope
  • The state may be seeking to convert an existing contract to be the Medicaid RAC
  • In May 2013, the state issued an RFP for Medicaid RAC services; proposal responses were due June 2013, subsequently extended to November 2013


Massachusetts

  • SPA Submitted 12/30/2010
  • SPA Approved 2/23/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state released a Request for Response (RFR) for 2 years of RAC services. Responses were due 11/21/2011.
  • The state has awarded the RAC contract to three contractors.
    -  At least one known contract (with HMS) was executed in March 2012.
    -  Per state documentation, Connolly, Inc. and Washington & West, LLC were also selected; the contract status with each was unknown as of April 2013.


Michigan

  • SPA Submitted 12/13/2010
  • SPA Approved 3/9/2011
  • The state is not seeking any exemptions from RAC audit scope
  • An RFP for Medicaid RAC services was issued in December 2011, with responses due January 2012
  • The RAC contract has been awarded to HMS


Minnesota

  • SPA Submitted 12/21/2010
  • SPA Approved 3/17/2011
  • The state is seeking exemptions from RAC audit scope
  • A blanket fraud, waste and abuse technology RFP was issued which included a Medicaid RAC scope.
  • A subsequent Work Order Contract Statement of Work for Recovery Audit was issued in late March 2012, with responses due in April 2012
  • In May 2012, the state issued an intent to negotiate a contract with HMS, and the contract was executed in October 2012


Mississippi

  • SPA Submitted 11/3/2010
  • SPA Approved 1/26/2011
  • A RAC RFP was issued December 2010 and closed January 2011. The RAC scope includes improper payment identification, claims dispute assistance, claims tracking, and systematic reporting; the state wants any RAC to not duplicate any other program integrity effort.
  • The RAC contract was awarded to PRGX (March 2011)


Missouri

  • SPA Submitted 12/20/2010
  • SPA Approved 2/16/2011
  • The state is not seeking any exemptions from RAC audit scope.
  • A RAC RFP was issued early January 2011 and put on hold pending “…final promulgation of a final rule on recovery audits by CMS.” The RFP closed October 2011.
  • The state awarded the RAC contract to sole bidder Cognosante


Montana

  • SPA Submitted 12/20/2010
  • SPA Approved 3/9/2011
  • The state is seeking exemptions from RAC audit scope
  • Montana has received a waiver from CMS to join ID, WY, and UT in issuing a combined Medicaid RAC RFP
  • In May 2012, the state issued a joint RFP for RAC services with the Medicaid programs in Alaska, Idaho, and Utah
  • In June 2012, the state announced that the multi-state RAC contract was awarded to HMS; no other vendors submitted proposals


MP

  • SPA Submitted 1/11/2011
  • SPA Approved 2/10/2011
  • Exceptions sought


Nebraska

  • SPA Submitted 12/29/2010
  • SPA Approved 2/16/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state issued an RFP for Medicaid RAC services on 6/11/2012, with a proposal submission due date of 8/24/2012
  • In October 2012, the state announced its intent to award the RAC contract to HMS, and a subsequent contract was executed in December 2012


Nevada

  • SPA Submitted 12/28/2010
  • SPA Approved 3/9/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued August 2011, and closed September 2011
  • The state has awarded a contract with HMS to perform RAC services


New Hampshire

  • SPA Submitted 12/21/2010
  • SPA Approved 2/28/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued October 20, 2010 with a due date of November 2010; RAC scope includes improper payment identification, overpayment recovery and tracking/reporting
  • The RAC contract has been awarded to Goold Health Systems (July 2011)


New Jersey

  • SPA Submitted 12/29/2010
  • SPA Approved 2/23/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state has designated HMS as its RAC contractor through an existing contract (April 2011)
  • In April 2013, the state issued an RFP for Medicaid RAC services with proposals due May 2013
  • In October 2013, the state re-awarded the RAC contract to HMS


New Mexico

  • SPA Submitted 12/6/2010
  • SPA Approved 2/25/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued November 2010 and closed December 2010; RAC scope includes auditing work bundled with Third Party Liability (TPL) and Program Integrity (PI) Efforts
  • The RAC contract was awarded to HMS


New York

  • SPA Submitted 12/22/2010
  • SPA Approved 3/8/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state has designated HMS as its RAC contractor through an existing contract (April 2011)


North Carolina

  • SPA Submitted 12/13/2010
  • SPA Approved 2/17/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state converted an existing contract with Public Consulting Group (PCG) to be the Medicaid RAC (January 2012)
  • In June 2012, the state issued an RFP to perform RAC services and non-RAC post-payment provider reviews. In September 2012, the state contracted with HMS to perform the services described in its RFP.
  • Medicaid RAC responsibilities are shared between two prime contractors (PCG and HMS) who operate under different contracts.


North Dakota

  • SPA Submitted 12/21/2010
  • SPA Approved
  • The state is seeking exemptions from RAC audit scope
  • A RAC RFP was issued May 2011 and closed May 2011; RAC scope includes the identification and collection of overpayments and identification of underpayments to providers. Additionally, ND’s RAC should suggest ways to help the state identify further improper payments.
  • The RAC contract was awarded to Cognosante LLC (July 2011)


Ohio

  • SPA Submitted 12/22/2010
  • SPA Approved 3/22/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued January 2011 and closed March 2011; RAC scope includes overpayment and underpayment identification, and quality and control of Medicaid services provided.
  • The RAC contract was awarded to CGI (May 2011)


Oklahoma

  • SPA Submitted 12/30/2010
  • SPA Approved 2/9/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state issued a RAC-related Request for Information in January 2012
  • In October 2012, the state issued an RFP for a Recovery Audit Contractor, with a proposal due date of 11/21/2012
  • The state awarded the work to HMS in June 2013, and the contract was executed the following August


Oregon

  • SPA Submitted 1/26/2011
  • SPA Approved 2/18/2011
  • The state is not seeking any exemption from RAC audit scope
  • A RAC RFP was issued February 2011 and closed March 2011; RAC Scope includes auditing and claims reviews for a variety of types of services. The scope also includes third party liability and the identification of improper payments.
  • The state awarded the RAC contract to HMS


Pennsylvania

  • SPA Submitted 12/23/2010
  • SPA Approved 3/11/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued June 2010; RAC scope includes Retrospective review or audits for inpatient Hospital including DRG validation, Inpatient/Outpatient laboratory services, Physician services, FQHC and RHC services, ASC services, DME services, and Other services as identified by PA
  • The contract was awarded to CGI with HMS as a subcontractor (November 2010)


Puerto Rico

  • SPA Submitted 12/27/2010
  • SPA Approved 2/9/2011
  • Exceptions sought


Rhode Island

  • SPA Submitted 12/17/2010
  • SPA Approved 12/31/2010
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued December 2010 and closed January 2011; RAC scope includes comprehensive recovery audit work for the 4 programs that make up the Executive Office of Health and Human Services (EOHHS). Scope of work from proposal also includes Accounts Payable Audit.
  • On 9/4/2012, PRGX announced that it had been awarded the comprehensive RAC contract


South Carolina



South Dakota

  • SPA Submitted 11/9/2010
  • SPA Approved 1/27/2011
  • The state is seeking exemptions from RAC audit scope
  • In January 2011, CMS approved a time-limited exception to implement a RAC contract


Tennessee

  • SPA Submitted 12/28/2010
  • SPA Approved 3/23/2011
  • The state is not seeking any exemptions from RAC audit scope
  • A RAC RFP was issued October 2010 and closed January 2011; RAC scope includes Fee For Service (FFS) and Encounter Claims Data
  • The RAC contract was awarded to HMS
  • In January 2014, HMS opted not to renew the contract it held for the RAC scope of work


Texas

  • SPA Submitted 12/29/2010
  • SPA Approved 3/9/2011
  • The state is seeking exemptions from RAC audit scope
  • The state issued an RFP for RAC services in October 2011; responses were due November 2011.
  • Following a tentative contract award and a subsequent award withdrawal, the RFP procurement project was canceled on 5/8/2012.
  • The state reissued an RFP for RAC services in June 2012, with responses due in July 2012
  • In September 2012, the state announced tentative contract awards to two prime RAC vendors: CGI Federal, Inc. and HMS, contingent on successful contract negotiations with each vendor.
  • In March 2013, the state announced final award of the RAC contract to HMS.

 



Utah

  • SPA Submitted 12/28/2010
  • SPA Approved 3/21/2011
  • A RAC-like RFP was issued in August 2010 and awarded to HMS; the scope included identifying and collecting improper payments, conducting risk assessments, and identifying best practices and covers 2008-2009 only.
  • Utah received a waiver from CMS to join ID, MT, and WY in issuing a combined Medicaid RAC RFP
  • In May 2012, the state issued a joint RFP for RAC services with the Medicaid programs in Alaska, Idaho, and Montana
  • In June 2012, the state announced that the multi-state RAC contract was awarded to HMS; no other vendors submitted proposals


Vermont

  • SPA Submitted 12/30/2010
  • SPA Approved 2/16/2011
  • The state is not seeking any exemptions from RAC audit scope
  • In March 2012, CMS approved a time-limited exception to implement a RAC contract


Virgin Islands

  • SPA Submitted 12/14/2010
  • SPA Approved 3/4/2011
  • Exceptions sought


Virginia

  • SPA Submitted 12/16/2010
  • SPA Approved 3/7/2011
  • The Commonwealth is not seeking any exemptions from RAC audit scope
  • The Commonwealth issued an RFP for RAC services in March 2012
  • In June 2012, the RAC contract was awarded to HMS


Washington

  • SPA Submitted 12/17/2010
  • SPA Approved 1/25/2011
  • The state is not seeking exemptions from RAC audit scope
  • An RFP for Medicaid RAC services was originally issued in December 2011, with a due date of 12/22/2011. The RFP was subsequently re-issued on 12/22/2011, with the latest due date being 2/23/2012.
  • On 3/28/2012, the state announced that CGI Federal, Inc. was the “apparent successful bidder” for the Medicaid RAC RFP


West Virginia

  • SPA Submitted 1/4/2011
  • SPA Approved 3/28/2011
  • The state is not seeking any exemptions from RAC audit scope
  • Procurement
    -  A RAC RFP was issued in May 2012, with a response due date in July 2012. Claim types to be audited under the RFP scope were limited to medical, dental, and DME.
    -  A separate RAC RFP focusing exclusively on pharmacy claims was issued June 2012, and had a proposal due date of August 9; this pharmacy-only RAC RFP was subsequently canceled
  • Award
    -  In September 2012, the state awarded the RAC contract covering medical, dental, and DME claims to HMS
    -  In October 2013, HMS opted not to renew the contract it held for the RAC scope of work


Wisconsin

  • SPA Submitted 12/23/2010
  • SPA Approved 3/14/2011
  • The state is not seeking any exemptions from RAC audit scope
  • The state issued a RAC Request for Service under the State of Minnesota Data Analytics Master Contract Program on 8/1/2012, with a proposal submission date of 8/24/2012
  • The RAC contract has been awarded to HMS


Wyoming

  • SPA Submitted 12/28/2010
  • SPA Approved
  • Wyoming received a waiver from CMS to join ID, MT, and UT in issuing a combined Medicaid RAC RFP.
  • Despite the waiver, the state issued a RAC RFP exclusively for Wyoming Medicaid on 1/4/2012, with a proposal submission deadline of 2/24/2012. The RFP was subsequently cancelled.
  • The state negotiated a contract with Myers & Staffer LC to perform Medicaid RAC services (January 2013)