Expansion of NC Medicaid Recoupments

Medicaid recoupments actions have skyrocketed in the past year.  But, in the upcoming year, a new group of health care providers will be targeted for recoupment actions.  According to the February 2013 Medicaid Bulletin, health care providers that  serve the Medicaid population with inpatient and outpatient hospital care, long-term care, laboratory services, x-ray services, and specialized outpatient therapy claims.

DMA has partnered with HMS to become the 2nd RAC vendor for North Carolina.

What is a RAC?

In the most simple terms: A RAC is an entity hired by the State to review Medicaid payments to health care providers and, subsequently, recoup the Medicaid overpayents for the State.

This past year hundreds of health care providers in the mental health fields, personal care services, and outpatient behavioral health services have received Tentative Notices of Overpayment. Some Notices claim repayment amounts in the millions.

Well, now, on to the hospitals…Imagine how large hospital recoupments will be….


About kemanuel

Medicare and Medicaid Regulatory Compliance Litigator

Posted on February 4, 2013, in Division of Medical Assistance, Health Care Providers and Services, Medicaid, Medicaid Recoupment, Mental Health, North Carolina, Outpatient Behavioral Health, Personal Care Services, RAC, Tentative Notices of Overpayment and tagged , , , , , , , . Bookmark the permalink. Leave a comment.

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