Recovery Audit Program

Mission - The Recovery Audit Program’s mission is to identify and reduce Medicare improper payments through the efficient detection and collection of overpayments made on claims of health care services provided to Medicare beneficiaries, and the identification of underpayments to providers so that the CMS can implement actions that will prevent future improper payments in all 50 states.

Background - The national Recovery Audit program is the product of a successful demonstration program that utilized Recovery Auditors to identify Medicare overpayments and underpayments to health care providers and suppliers in randomly selected states. The demonstration ran between 2005 and 2008 and resulted in over $900 million in overpayments being returned to the Medicare Trust Fund and nearly $38 million in underpayments returned to health care providers. As a result, Congress required the Secretary of the Department of Health and Human Services to institute (under Section 302 of the Tax Relief and Health Care Act of 2006) a permanent and national Recovery Audit program to recoup overpayments associated with services for which payment is made under part A or B of title XVIII of the Social Security Act.

Each Recovery Auditor is responsible for identifying overpayments and underpayments in approximately ¼ of the country. The Recovery Audit Program jurisdictions match the DME MAC jurisdictions.  

The Recovery Auditor in each region is as follows:

Region A:  Performant Recovery 

Region B:  CGI Federal, Inc. 

Region C:  Connolly, Inc. 

Region D:  HealthDataInsights, Inc.

All correspondence, Web sites and call centers will be in the name of the Recovery Auditors above. Click the link below to obtain contact information for each Recovery Auditor.

04/03/13 - CMS has posted revised provider (excluding physician and supplier) Additional Documentation Request Limits and revised supplier Additional Documentation Limits on the Provider Resources page. 

12/18/12 - Recovery Audit  Program Myths

CMS has posted a Recovery Audit  Program Myths document in the Download section below.  This document hopes to provide correct information on the Medicare Fee-for-Service Recovery Audit Program. 

10/22/12 - Change in Recovery Auditor for Some Providers

If a provider is located in any state other than Missouri, Kansas, Iowa or Nebraska (i.e. Jurisdiction 5 for Wisconsin Physician Services (WPS), and WPS is their Medicare Administrative Contractor (MAC), there has been a change in their Recovery Auditor. As of 10/22/12 the Recovery Auditor for these providers is HealthDataInsights.

This change occurred because the Centers for Medicare & Medicaid Services (CMS) completed a contracting transition involving the MAC. This transition did not impact the provider’s MAC but the transition required the change in the Recovery Auditor.  

All impacted providers will be notified by HealthDataInsights via postal mail.

All open additional documentation requests and any requests where a demand letter has not been generated were canceled and closed. Claims in process and claims data from the other Recovery Auditors will not be shared with HealthDataInsights

Note:  This does not impact providers in Jurisdiction 8 where WPS is also the Medicare Administrative Contractor.  The change in Recovery Auditor is only specific to those providers who originally had WPS pay their claims as the national fiscal intermediary.

Do you have questions or comments about the Recovery Audit Program? Please e-mail us at: RAC@cms.hhs.gov. Please Do Not send Personal Health Information to this e-mail address. Thank you.