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This document presents an executive summary and findings from an evaluation of Recovery Audit Contractors (RACs) regarding their referrals of potential fraud to the Centers for Medicare & Medicaid

How to fill out recovery audit contractors fraud

How to fill out Recovery Audit Contractors’ Fraud Referrals

1. Gather relevant documentation regarding the claim or billing issue.
2. Identify and document the specific instances of potential fraud.
3. Fill out the fraud referral form completely, ensuring all sections are accurately completed.
4. Attach all relevant documentation that supports the referral.
5. Submit the completed fraud referral to the appropriate Recovery Audit Contractor contact point.

Who needs Recovery Audit Contractors’ Fraud Referrals?

1. Healthcare providers submitting claims to Medicare or Medicaid.
2. Insurance companies looking to report suspected fraudulent activity.
3. Auditors and compliance officers within healthcare organizations.

People Also Ask about

What does a RAC recovery audit contractor do?

RAC is the abbreviation for “recovery audit contractor.” The purpose of an RAC is to identify overpayments and underpayments made by the Medicare program under Part A and Part B. The RACs are also responsible for the recoupment of overpayments made to providers.

What does a recovery audit contractor RAC do?

RAC is the abbreviation for “recovery audit contractor.” The purpose of an RAC is to identify overpayments and underpayments made by the Medicare program under Part A and Part B. The RACs are also responsible for the recoupment of overpayments made to providers.

What is the goal of the recovery audit contractor program?

The goal of the recovery audit program is to identify improper payments made on claims for services provided to Medicare beneficiaries. Improper payments may be overpayments or underpayments. Overpayments can occur when health care providers submit claims that do not meet CMS coding or medical necessity policies.

What triggers a RAC audit?

The RACs will primarily conduct two types of audits: automated and complex. An automated review relies on an analysis of claims data to make a determination.

What triggers a RAC audit?

The Affordable Care Act (ACA) requires Medicaid agencies to contract with Recovery Audit Contractors (RACs) to identify and recover overpayments and to identify underpayments.

For pdfFiller’s FAQs

What is Recovery Audit Contractors’ Fraud Referrals?

Recovery Audit Contractors’ Fraud Referrals are reports submitted to the appropriate federal authorities regarding suspected fraudulent activities identified by Recovery Audit Contractors during their audits of claims and payments.

Who is required to file Recovery Audit Contractors’ Fraud Referrals?

Healthcare providers, suppliers, and other entities that identify potential fraud during the audit process are required to file Recovery Audit Contractors’ Fraud Referrals.

How to fill out Recovery Audit Contractors’ Fraud Referrals?

To fill out Recovery Audit Contractors’ Fraud Referrals, entities should provide detailed information about the suspected fraud, including the nature of the fraud, relevant claims and payments, and any supporting documentation that can help substantiate the referral.

What is the purpose of Recovery Audit Contractors’ Fraud Referrals?

The purpose of Recovery Audit Contractors’ Fraud Referrals is to alert federal law enforcement and oversight organizations, like the Office of Inspector General, to potential fraud in the Medicare and Medicaid programs, enabling them to investigate further.

What information must be reported on Recovery Audit Contractors’ Fraud Referrals?

Recovery Audit Contractors’ Fraud Referrals must include information such as the healthcare provider's details, the specific claims involved, the suspected fraud's nature, relevant dates, and any documentation that supports the allegations.