Are RAC audits really designed to uncover and stop Medicare fraud?
A. Not really. The RAC audit program is more designed to address overpayments and curb perceived provider “abuse” of the program – not necessarily address enforcement issues around Medicare fraud. However, the RAC Statement of Work does require reporting of potential fraudulent activities to CMS / OIG for follow-up. In addition, it is important to note that there have been several whistleblower cases recently investigated and settled by the Department of Justice in conjunction with major RAC audit focus areas (inpatient v. observation, inpatient-only list, etc.).
