Recovery Audit Contractors' Fraud Referrals

摘要

Centers for Medicare and Medicare (CMS) contracts with RACs to identify improper payments of Medicare Part A and Part B claims. RACs conduct postpayment reviews to identify overpayments and underpayments and recoup any overpayments they identify. RACs receive payment based on the amount of improper payments identified. CMS conducted a 3-year RAC demonstration project from March 2005 through March 2008 that was designed to (1) detect and correct past improper payments in the Medicare fee-for-service program and (2) provide information to CMS and to the Medicare claims processing contractors that could help protect the Medicare trust funds by preventing future improper payments.