Parts C and D Recovery Audit Program
About the Program
The Medicare Parts C and D Recovery Audit Program was created to identify and correct past improper payments to Medicare providers and implement procedures to help the Centers for Medicare & Medicaid Services (CMS), Medicare carriers, fiscal intermediaries and Medicare Administrative Contractors (MACs) implement actions that will prevent future improper payments. Communication about audit results and trends leads to continuous process improvement and more accurate payments, and helps plan sponsors correct issues in a timely manner.
Who We Are
The Center for Program Integrity (CPI) serves as CMS' focal point for all national and statewide Medicare and Medicaid programs and Children's Health Insurance Program (CHIP) integrity fraud and abuse issues. Identifying and preventing improper payments in Medicare Parts C and D is central to that work. CMS/CPI manages the Medicare Part D Recovery Audit Program as a component of that goal.
Understand the Audit Process
The initial audit process involves three phases conducted by the Medicare Part D RAC and DVC.
Learn How to Appeal
There are three levels of the appeals process. Learn about the process and what is required to appeal.
New! Resource Page
Find all of the resources you need including definitions, templates, FAQs, Fact Sheets, HPMS Memos and more.