Oberheiden P.C.

Since RAC auditors work on a fee-for-service basis, this means that the RAC team is not on your side during an audit. While RAC auditors’ contracts with CMS require them to identify both overpayments and underpayments, audits tend to focus almost exclusively on identifying reimbursements paid improperly. When facing a RAC audit, it is critical to have experienced defense counsel. Targeted providers and businesses need to engage a defense team that can communicate effectively on their behalf, challenge auditors’ authority, and help steer the audit toward an accurate determination of coverage. Flawed Medicare coverage determinations during RAC audits are not uncommon, so engaging a defense team that is familiar with the complex substantive and procedural issues involved in these inquiries is essential.