CMS launches Medicaid recovery audit program

Earlier this month, the Centers for Medicare and Medicaid Services published a final rule to establish the Medicaid Recovery Audit Contractors program in a bid to recoup overpayments and duplicate payments.

"We are building on an already successful program that targets improper payments in our health care programs and recovers those dollars, making Medicare and Medicaid more reliable and responsible," said Kathleen Sebelius, secretary of the U.S. Health and Human Services department.

Health Data Management reports that according to figures from the Obama administration, Medicare's RAC program – upon which the Medicaid program was modeled – recovered $670 million in overpayments during its 2011 rollout phase. Estimates for the Medicaid RAC put recouped savings at more than $2 billion over five years, $900 of which is projected to be returned to states.
The news source notes that leveraging data analytics and reporting software has expedited management of the program in terms of importing data to generate audit status reports, gauge financial risks, and identify processes that require improvement – for example, which diagnosis-related groups were frequently overpaid. 

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