New York RAC Information

Protecting the Interests of Health Care Providers

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If you are a medical provider in the New York area, you are likely concerned about the newly expanded recovery audit contractor (RAC) program. Perhaps you became aware of this program during its demonstration period in New York or other states, or perhaps you have no experience with the program at all. Either way, you need to be prepared for the possibility of a RAC audit during the current nationwide rollout.

At the law firm of Wachler & Associates, P.C., we counsel medical providers in New York, New Jersey, Connecticut and nationwide on a range of complex challenges, including the RAC audit process. If you are facing an audit, looking to appeal the results of an audit or have any other concerns about the RAC program, contact us today.

Understanding the New Medicare Audit Process

A RAC is a private company that audits medical providers on behalf of the Centers for Medicare and Medicaid Services (CMS) to investigate suspected cases of Medicare overpayment and underpayment. The RAC is paid a contingency fee — a percentage of the money it recovers for the CMS or for providers who were underpaid.

The RAC for Region A — which includes New York, New Jersey and Connecticut — is Diversified Collection Services, Inc. Underpayments were only a very small percentage of cases during the demonstration program, and we have no reason to believe this will change.

All of the following types of medical providers, if they serve Medicare recipients, should be prepared for audits and for the possibility that payment demands will be made:

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

Local and National Experience With RAC Audits

RAC audits have been carried out in New York State for several years during the demonstration phase of the program, and the state became part of the permanent program on March 1, 2009. In Connecticut and New Jersey, RAC audits will begin sometime after August 1, 2009.

Our attorneys have represented providers in New York during the demonstration program and are fully prepared for the changes that have been made to the program for its nationwide rollout.

We have a track record of success at representing health care providers and protecting their interests in cases involving RAC audits, Medicare audits and other medical payor audits. Our reputation within and commitment to the health law community are also demonstrated by our involvement in professional organizations and our publications and speaking engagements.

When you need guidance from experienced lawyers with respect to a RAC audit or appeal in the New York region, don’t hesitate to contact us at Wachler & Associates, P.C.

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