RAC Outreach Halted as GAO Probes Contract Protests

BALTIMORE — The four recently named recovery audit
contractors poised to begin provider education this month were told
last week to halt all work pending a review of protests filed by
two companies that failed to win RAC contracts, CMS said.

The new RACS, which were tabbed in October to ferret out
Medicare overpayments and underpayments, were scheduled to
introduce the program via what CMS called “town hall-type meetings”
this month, but protests to the Government Accountability Office by
Viant and PRG-Schultz, which lost out in the contracting process,
derailed those plans. The GAO has 100 days to review the complaints
and issue a decision.

CMS said, however, it will hold a previously announced Special
Open Door Forum on the RACs this Wednesday.

“CMS staff will continue informing the provider community,” said
Connie Leonard, director of the division of recovery audit
operations for CMS. According to a notice from the agency, the
purpose of the forum is “to introduce providers to the new
contractors and provide more information about the RAC
program.”

The RAC program was mandated by the Tax Relief and Health Care
Act of 2006 as a way for CMS to identify Medicare overpayments and
underpayments for both Part A and Part B (which includes home
medical equipment providers). In a three-year demonstration project
involving six states—California, Florida, New York,
Massachusetts, South Carolina and Arizona—more than $900
million in overpayments was collected and $38 million found in
underpayments, according to CMS. (See CMS Rolls
Out Host of New Anti-Fraud Measures, HomeCare Monday,
Oct. 13.)

Those results propelled CMS to implement plans for permanent
RACs. After calling for bids, CMS in October awarded four
contracts—mirroring the DME MAC jurisdictions—and
charged the contract winners with establishing the program of
post-payment reviews, which will eventually roll out to all 50
states by 2010. The companies awarded the contracts included:

• Region A: Diversified Collection Services of
  Livermore, Calif., initially working in Maine, New Hampshire,
  Vermont, Massachusetts, Rhode Island and New York
• Region B: CGI Technologies and Solutions of
  Fairfax, Va., initially working in Michigan, Indiana and
  Minnesota
• Region C: Connolly Consulting Assoc. of
  Wilton, Conn., initially working in South Carolina, Florida,
  Colorado and New Mexico
• Region D: HealthDataInsights of Las Vegas,
  initially working in Montana, Wyoming, North Dakota, South Dakota,
  Utah and Arizona

Leonard said CMS did not know when the RACS would be able to
begin their outreach education.

“CMS will not be able to answer those questions until after the
GAO makes a determination concerning the protests,” she said.

To access Wednesday’s CMS Open Door conference, which is
scheduled from 2 to 3:30 p.m. EST, call 800/837-1935 and reference
conference ID 60227754.

For more information visit the RAC program.