MD Audit Shield – Prepare for RAC Auditing!

The federal government has introduced the "Recovery Audit Contract (RAC)" process to combat fraudulent medical claims by hiring private auditing companies to scrutinize medical records and billing across all states. Audits target providers billing fee-for-service Medicare, Medicaid, or commercial insurance, focusing on coding accuracy, medical necessity documentation, and payment correctness. Detected inconsistencies necessitate repayment plus interest, with limited success in appeals. Audits will continue every 45 days until fraud is unsubstantiated. The RAC program has already identified over $1 billion in overpayments in a subset of states, making it a critical procedure for medical practices to heed.