At Lowther | Walker, we understand how disruptive and overwhelming a Medicare Recovery Audit Contractor (RAC) audit can be for your healthcare organization.
Our seasoned RAC audit attorneys bring many years of experience responding to RAC audit requests to your medical business. We can help mitigate penalties associated with Medicare billing errors and defend providers facing criminal actions, including OIG investigations and prosecution.
Recovery Audit Contractors (RACs) are third-party entities contracted by the Centers for Medicare & Medicaid Services to identify and recover improper payments within Medicare and Medicaid programs. These contractors utilize sophisticated data analysis techniques to detect overpayments and underpayments made to healthcare providers, subsequently initiating recovery processes for identified discrepancies.
The RAC compensation model operates on a contingency fee basis, where contractors receive a predetermined percentage of successfully recovered funds. This performance-based payment structure ensures that RACs are directly invested in maximizing recovery efforts.
However, this incentive structure can create tensions in the healthcare audit landscape.
Since RAC revenue is directly tied to recovery amounts, contractors may adopt aggressive audit practices that prioritize financial recovery over collaborative relationships with healthcare providers. This presents several challenges for healthcare providers:
The federal agency’s decision to begin an audit may be due to a computer model suggesting an error in your data. Or it could be the result of a patient complaint. But once auditors have access to your healthcare company’s data, you’re at their mercy unless you hire a skilled RAC audit defense lawyer such as Lowther | Walker.
Whether you’re a family dental practice owner or an urgent care provider with a large staff across multiple properties, you can call Lowther | Walker for effective RAC audit responses.
Recovery audits fall into two distinct categories:
The steps within the RAC audit process proceed as follows:
During this stage, RACs evaluate all provided materials against current Medicare compliance standards. The evaluation process references applicable reimbursement policies and regulatory frameworks to ensure accurate determinations.
Upon completion of their analysis, RACs issue formal communications detailing their conclusions. If they discover payment irregularities, healthcare facilities receive specific information regarding the monetary amounts involved and detailed explanations supporting the audit determinations.
Suspicions of fraud will immediately trigger an audit by an investigator who may then recommend action, such as payment suspensions, to the Department of Justice. If your organization receives an audit request signed by a fraud investigator, you may wish to begin building your legal defense by hiring a healthcare fraud attorney. In cases where data auditors find issues such as billing irregularities, the next step will be requesting records.
Healthcare organizations must remit identified overpayments to Medicare. Providers maintain the authority to contest audit conclusions through formal dispute mechanisms when they identify potential review errors.
The concluding phase encompasses either addressing payment discrepancies or auditors referring the provider for criminal charges. Though Recovery Audit Contractor examinations primarily target the identification and recovery of improper payments from healthcare entities, the discovery of fraudulent activities or deliberate wrongdoing may trigger referrals to federal investigative agencies or the Department of Justice for possible criminal proceedings.
If you’ve received a RAC audit letter, there are several steps you can take to begin to protect your practice against criminal action.
1. Contact a healthcare audit lawyer to determine the scope of the audit
Lowther | Walker can respond to the auditor on your behalf, identifying audit scope and helping you craft a response based on your obligations under the law.
2. Collect documentation to identify the root cause for the audit request
RAC audits are often the result of specific billing patterns and irregularities. Lowther | Walker can help you identify the root cause for your request by reviewing your billing records, policies, and procedures alongside your administrator.
3. Considering disclosure options
Proactive identification and disclosure of billing errors can help prevent further federal government actions. As your legal representative, Lowther | Walker can help you explain the cause for any billing mistakes and show auditors your team is acting to resolve these errors to safeguard the business against potential penalties.
Healthcare providers turn to Lowther | Walker for our exceptional background proactively intervening during RAC audits and for our work in landmark healthcare fraud cases. Our background includes years of experience responding to Recovery Audit Contractors on behalf of Medicare and Medicaid providers.
Lowther | Walker’s practice is focused exclusively on federal cases. Our breadth of knowledge on federal laws governing healthcare audits is unparalleled.
We’ve handled RAC audits and appeals in nearly every state and can respond on short notice for in-person meetings with medical providers facing RAC audits across the country.
We step in early to control the narrative, respond to auditor questions and red flags, and help support you and your team through the audit process.
RAC audits target providers suspected of receiving improper Medicare payments. These reviews are conducted by private contractors under CMS guidelines. Audits may be triggered by:
If the RAC determines that overpayments occurred, you may:
Do not agree to repayment without a legal review of the RAC’s findings. Many “overpayments” are based on flawed assumptions or outdated coding rules.
Absolutely. RAC audits are not just administrative. They can trigger civil or even criminal inquiries. An experienced healthcare defense attorney can prevent serious consequences.
If your healthcare business is undergoing a RAC audit, the time to act is now. The attorneys at Lowther | Walker brings federal insight, proven audit response experience, and 24-hour legal services to protect your team during an RAC audit and appeal.
Book your free and confidential RAC audit defense consultation online or call (877) 208-7146 to speak with a healthcare audit defense lawyer today.
