Medicare Fee for Service Recovery Audit Program
Mission - The Medicare Fee for Service (FFS) 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 Medicare FFS Recovery Audit Program began as a demonstration required in the Medicare Prescription Drug, Improvement, and Modernization Act of 2003. The demonstration was conducted from March 2005 to March 2008 in six states to determine if Recovery Auditors could effectively be used to identify improper payments for claims paid under Medicare Part A and B. This demonstration allowed for additional review of Medicare claims for payment by utilizing Recovery Auditors on a contingency fee basis to identify and investigate claims with calculated risk. The demonstration established Recovery Auditors as a successful tool in the identification and prevention of improper Medicare payments. Section 1893(h) of the Social Security Act authorized the Recovery Audit Program expansion nationwide by January 2010.
CMS awarded new FFS RAC contracts on October 31, 2016 to:
Region 1 – Performant Recovery, Inc.
Region 2 – Cotiviti, LLC
Region 3 – Cotiviti, LLC
Region 4 – HMS Federal Solutions
Region 5 – Performant Recovery, Inc.
The Statements of Work for the new contracts, a map depicting the new regions, and contact information for each RAC are available in the Downloads section below. All correspondence, web sites and call centers will be in the name of the RACs above.
The original Medicare FFS RACs will be under contract with CMS until 2018 for administrative purposes. Providers may still receive correspondence related to claims adjusted under the original RAC contracts.
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.
- FY 2015 Medicare FFS RAC Report to Congress [PDF, 488KB]
- FY 2015 Medicare FFS RAC Appendices [PDF, 822KB]
- NEW - Medicare FFS RAC contact info (12.6.16) [PDF, 223KB]
- Medicare FFS RAC Map - November 2016 [PDF, 244KB]
- Nov. 30, 2016 RAC SOW Regions 1-4 [PDF, 517KB]
- Nov. 30, 2016 RAC SOW Region 5 [PDF, 1MB]
- Page last Modified: 02/01/2017 1:50 PM
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