Preparing for an RAC Audit Under the Affordable Care Act

Among the situations that create angst for today's physicians, being audited is second only to being sued for malpractice. When it comes to Medicare, the thought of receiving a recovery audit contractor (RAC) audit certainly is a frightening proposition.

In 2005, the RAC program was created to help the Centers for Medicare and Medicaid Services (CMS) reign in the high costs associated with improper payments made through Medicare. After a short and successful (approximately $1 billion for the CMS) stint as a pilot program that was limited to 3 then expanded to 6 states, Congress made the program permanent and expanded it nationally in 2008. Although the detection of fraud and abuse has been a priority for the CMS, the stakes substantially increased with the advent of the Patient Protection and Affordable Care Act (PPACA) that Congress and the president enacted in late 2010.