SoonerCare RAC program ends

Posted on: 8/15/18

The Medicaid Recovery Audit Contractor (RAC) program for Oklahoma has ended, for now.  

The Affordable Care Act required all states to set up Medicaid RAC programs, under which private contractors look for overpayments to providers. On July 20, the Center for Medicare & Medicaid Services (CMS) approved the Oklahoma Health Care Authority’s request for an exception from the RAC program requirement for SoonerCare, Oklahoma’s Medicaid program. The Affordable Care Act required all states to set up Medicaid RAC programs, under which private contractors look for overpayments to providers. RACs receive a percentage of the overpayment recoveries.

In applying for the RAC exception, OHCA cited results of the federal Payment Error Rate Measurement program, which found that Oklahoma’s Medicaid program error rate has been far less than the national average.

CMS granted the RAC exception to Oklahoma for a two-year period. It was approved retroactively to April 1, 2018. Hospitals should receive no further requests for medical records for RAC audits. However, some RAC audits that are already underway have not yet been completed, so hospitals may still receive notices of audit results. RAC audit results that are under appeal are unaffected by the program’s end.

HMS, the RAC firm for Oklahoma, will continue to work with the SoonerCare program as its Third Party Liability (TPL) contractor. Medicaid is the payer of last resort, and states are required to actively look for other parties with responsibility for paying Medicaid claims.

The end of Oklahoma’s Medicaid RAC program does not mean that claims will not be audited. OHCA has broad authority to conduct audits to ensure program integrity. (Rick Snyder)