Recovery Audit Program
Mission - The Recovery Audit Program’s mission is to identify and correct 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.
09/25/13 - The Therapy Cap Web page now has a link on the Recovery Audit Program Prepayment Review Demonstration Web page. Please find the link in the CMS Related Links section.
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.
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.
- May 13, 2013 - The Recovery Audit Program and Medicare Slides [PDF, 226KB]
- FY 2011 Report To Congress [PDF, 1MB]
- 12/18/12 - RAC Program Myths [PDF, 271KB]
- FY 2010 Report To Congress [PDF, 769KB]
- Sept.1, 2011 Recovery Audit Program Final SOW [PDF, 292KB]
- RAC Contact Information-Apr2013 [PDF, 189KB]
- MM 6183 Limitation on Recoupment [PDF, 117KB]
- The Medicare Appeals Process Brochure [PDF, 1MB]
- Page last Modified: 10/21/2013 5:08 PM
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