Regarding the Recovery Audit Contractor (RAC)



The South Carolina Department of Health and Human Services (SCDHHS) gives notice of the following action regarding the Recovery Audit Contractor (RAC) program under the State Plan under Title XIX of the Social Security Act Medical Assistance Program (Medicaid).

The Medicaid Recovery Audit Contractor program was established as a measure for States to promote the integrity of the Medicaid program.  Federal regulations that went into effect January 1, 2012, establish the activities for the RACs.  RACs review claims submitted for goods and services for which payment has been made under the Medicaid program, in order to identify underpayments and overpayments and recoup overpayments for the State.  RACs are not allowed to review claims that are older than 3 years from the date of the claim, unless approved by the State.  SCDHHS has had a recovery audit program in place since 2009 and recently initiated a new contract with HMS, Inc., under a competitive procurement, to be the South Carolina RAC.  The State is seeking a State Plan Amendment in order to allow the RAC to review claims that are older than 3 years.  This is necessary to better align with records retention requirements and to comply with audits conducted by the U.S. Department of Health and Human Services Office of Inspector General.  The SPA will also update the contingency fee rate for underpayment identification.

Copies of this notice are available at each County Department of Health and Human Services Office and at www.scdhhs.govfor public review.  Additional information regarding this action is available upon request at the address cited below.

Any written comments submitted may be reviewed by the public at SCDHHS, Bureau of Compliance and Performance Review, Jefferson Square Building, 1801 Main Street, Columbia, South Carolina, Monday through Friday between the hours of 9:00 A.M. and 5:00 P.M.

Print Version

Report Fraud