Department of Community Health Launches Medicaid RAC Review of Hospice and Nursing Home “Patient Liability” Deductions

State Review Exceeds Federal Authority with Improper Look-Back Period

Hospices and nursing homes in Georgia are getting their first taste of Georgia’s newly established Medicaid RAC (recovery audit contractor) program. Healthcare providers that participate in the Medicare program are by now familiar with the concept (if indeed not the practice) of the Medicare RACs – private entities that contract with the Centers for Medicare & Medicaid Services (“CMS”) on a contingency fee basis to identify and recoup Medicare overpayments. The Medicare RAC program, which began as a six-state demonstration project, went nationwide in 2010. Flushed with its success, the federal government expanded the RAC program into Medicaid via the Patient Protection and Affordable Care Act (“PPACA”), which was enacted in 2010.

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