Get Full Government Meeting Transcripts, Videos, & Alerts Forever!
Get email alerts on the Program Integrity topic
No spam. Unsubscribe anytime.
DHS says CMS approved exemption from recovery audit contractor requirement; committee hears how DHS polices fraud and overpayment
Summary
Department of Human Services staff told the committee they obtained a CMS exemption from the federal recovery audit contractor requirement because DHS already employs multiple program‑integrity layers; Representative Latham asked for clarification and DHS described retrospective reviews, a payment‑integrity office, the Office of Medicaid Inspector General and referral to the Attorney General's Medicaid Fraud Control Unit.
Elizabeth Pittman, director for the Division of Medical Services at the Department of Human Services, presented a rule seeking exemption from the CMS recovery audit contractor (RAC) requirement. She told the committee DHS believes the RAC requirement is unnecessary and said "CMS has agreed and approved this exemption," adding the exemption would have no cost to the state.
Representative Latham asked for clarification: "I don't have a problem with this rule, but can you expand a little bit on what a recovery audit contractor is? What do they do now?" Pittman replied that RACs typically operate on a contingency basis to identify fraud, waste or abuse by Medicaid providers and to recover overpayments; RACs take a percentage of recoveries. She said state law prevents entering contingency arrangements for certain recoveries, so DHS relies on internal teams and other external integrity partners.
Pittman outlined DHS's program‑integrity layers: internal retrospective review teams that assess medical necessity and billing, an external payment‑integrity office, the Office of Medicaid Inspector General that flags credible allegations, and referral to the Attorney General's Medicaid Fraud Control Unit for civil and criminal prosecution. The committee reviewed the rule without objection.
