Chicago RAC Information

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If you provide health care services to Medicare recipients, you are probably aware of the recovery audit contractor (RAC) program that is currently in the process of being expanded nationwide. But are you prepared for the possibility of a RAC audit and subsequent collection demand?

At the law firm of Wachler & Associates, P.C., we are exclusively devoted to health care law, and our attorneys are highly knowledgeable about the RAC program, including recent changes to the program.

If you are being audited or need to appeal the results of an audit, don't hesitate to contact us to discuss how we can help you. Our firm assists clients with RAC audits in Chicago; throughout Illinois, Indiana and Wisconsin; and nationwide.

After a demonstration program in several states, the RAC process is rapidly being expanded nationwide in accordance with a 2006 federal law. The Centers for Medicare and Medicaid Services (CMS) has contracted with several private companies to conduct RAC audits at health care entities such as the following:

• Hospitals and health systems
• Skilled nursing facilities (SNFs)
• Durable medical equipment (DME) providers
• Hospice and home health agency (HHA) providers
• Physicians and physician groups
• Ambulatory surgery centers (ASCs)
• Radiology providers and independent diagnostic testing facilities (IDTFs)

We have reason to believe that hospitals and health systems will at least initially be the focus of the RAC audit program. All types of health care providers in the Chicago area that serve Medicare recipients are subject to being audited.

The nationwide RAC audit program is being rolled out on a state-by-state basis during 2009. RAC audits are being conducted in Indiana as of March 1, while the program will begin in Illinois and Wisconsin no earlier than August 1. All three states are in RAC Region B, and CMS has awarded the audit contract for this region to CGI Technologies and Solutions, Inc.

Because RACs are compensated on a contingency fee basis, they are highly motivated to identify and pursue cases of potential overpayment. RACs are also paid when they identify underpayments, but these constituted only a small minority of cases during the program's demonstration period.

In Region B, CGI will be paid 12.50 percent of funds collected from and/or returned to Medicare providers as a result of improper payments detected during the RAC audit process. This is the highest percentage in the country. Audited health care providers in the area clearly need attorneys who will vigorously pursue their interests and are knowledgeable about the audit and appeals processes.

Contact us to learn more about the high quality services our lawyers provide to health care providers in the Chicago; throughout Illinois, Indiana and Wisconsin; and nationwide.