CMS FAQs set the record straight about recovery audit contractors and integrity contractors

According to recently released guidelines from the Centers for Medicare & Medicaid Services (CMS), Medicaid recovery audit contractors (RACs) will not be replacing existing program integrity contractors. Rather, as McKnight's explains, Medicaid integrity contractors (MICs) will offer different services than RACs.

Both groups will be identifying overpayments, underpayments, duplicate payments and other irregularities by reviewing claims, but MICs will also provide information on fraud trends at both a regional and national level.

CMS noted that while legislation does not prohibit states from attempting to contract with a current MIC, an entity acting as an MIC and Medicaid RAC in the same state could lead to a conflict of interest. Six contractors currently serve as MICs: Thomson Reuters, IntegriGuard, AdvanceMed, Health Integrity, Island Peer Review Organization and Booz Allen Hamilton.

To avoid duplication of effort among RACs, MICs, zone program integrity contractors and state agencies contractors, state and Medicaid RACs under contract are required to coordinate with other entities performing similar audits.

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