CMS Announces RAC Audits To Begin in New York State

The Centers for Medicare and Medicaid Services (CMS) announced that Performant Recovery, Inc., New York’s Medicare Fee-for-Service Recovery Audit Contractor (RAC) for Region 1, can begin recovery audit activity now that provider outreach is complete. Region 1 includes the following groups of states:  J8, WPS: Michigan and Indiana; J15, CGS: Ohio and Kentucky; JK, NGS: New York, Vermont, Massachusetts, Rhode Island, Maine, New Hampshire, and Connecticut.

Performant will perform post-payment reviews to identify and correct Medicare claims that contain improper overpayments and underpayments that were made under Medicare Parts A and B, for all provider types other than Durable Medical Equipment, Prosthetics, Orthotics, and Supplies (DMEPOS) and Home Health/Hospice. According to an estimate released on September 30, 2015, the group of states containing New York makes up approximately 12% of the national Part A and B workload. These reviews will not consider short-stay “patient status” reviews—unless the hospital is identified by Livanta, New York’s Quality Improvement Organization, for an additional audit.

Per CMS, the awards of these contracts seek to continue the implementation of many of the Recovery Audit Program enhancements designed to reduce provider burden, enhance program oversight, and increase transparency in the program.

For more information concerning RAC audits, please contact David R. Ross, Esq. or Mary T. Connolly, Esq.

David R. Ross is a Shareholder of the firm. Prior to joining the firm, and under former Governors Pataki and Spitzer, Mr. Ross served as the Acting Medicaid Inspector General for New York State. Prior to his service at the OMIG, Mr. Ross held several positions at the New York State Office of Alcoholism and Substance Abuse Services (OASAS), including Acting General Counsel, Deputy Counsel, and Associate Counsel. Mr. Ross handles both Medicare and Medicaid audits for providers of all types and sizes.

 Mary T. Connolly is an Associate of the firm and contributed to this article.  Her primary practice areas include health law, employment law, and litigation.


David Ross

About David Ross

David is Partner and concentrates his practice on Medicaid, Medicare and private insurance audits & investigations, Health Law including fraud and abuse, governmental investigations of all kinds, Medicaid compliance plans and Article 78 cases. He is head of our Government Investigations practice and also works in Healthcare Fraud & Abuse.