Houston RAC Information

Representing Hospitals, Doctors and Other Providers

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As of March 1, 2009, medical providers in Texas that serve Medicare recipients are subject to audits conducted under the federal government’s newly expanded recovery audit contractor (RAC) program. If you provide health care services in Houston or elsewhere, you could find that your medical and billing records are going to be audited under this program.

At Wachler & Associates, P.C. , our attorneys are familiar with the RAC audit process due to our representation of providers in other states that were audited during the program’s demonstration period. Our law firm is entirely devoted to health law, so we understand the unique circumstances confronting medical providers. If you are concerned about a RAC audit, don’t hesitate to contact us .

Making Sure Providers are Prepared for the Audit Process

Our attorneys represent clients that are being audited or that are looking to appeal the adverse results of an audit under the RAC program. Now that the program is being expanded nationwide, all medical providers in Houston, throughout Texas and elsewhere, including the following, should be prepared for the possibility of audits:

• Hospitals and health systems
• Hospice and home health agency (HHA) providers
• Physicians and physician groups
• Ambulatory surgery centers (ASCs)
• Radiology providers and independent diagnostic testing facilities (IDTFs)
• Skilled nursing facilities (SNFs)
• Durable medical equipment (DME) providers

During the demonstration program, hospitals and health systems received the greatest scrutiny, and we expect this pattern to continue at least in the near future.

No medical providers, regardless of the type of services they provide, should be unprepared for RAC audits of their records with regard to patients who are covered by Medicare.

Providing Vigorous Advocacy During RAC Audits and Appeals

As part of the RAC process, the private company that has been chosen to conduct audits in Texas and the other states in Region C — Connolly Consulting Associates, Inc. — will be paid a percentage of all funds recovered in the Houston area for the Centers for Medicare and Medicaid Services (CMS) due to overpayments or for medical providers due to underpayments.

Since underpayments have been only a small percentage of cases so far, the RACs are heavily motivated to pursue audits against medical providers aimed at uncovering evidence of alleged overpayment.

To help you respond to a RAC audit, the services of a vigorous legal advocate will be invaluable. Our lawyers are accustomed to going up against administrative agencies and their private partners on behalf of our clients.

We are fully familiar with the administrative appeals process and the particular five-step RAC appeals process that medical providers can use to contest the results of RAC audits.

Providers should also be prepared for Zone Program Integrity Contractor (ZPIC) audits. ZPICs are CMS contractors that look for overpayments and potential fraud. For these audits, each state has been assigned to a different contractor. Texas is located in Zone 4 for ZPIC audits, with Health Integrity, LLC as its contractor.

We have a track record of helping medical providers contain costs and protect their bottom lines. If you are facing a RAC audit, a ZPIC audit, another Medicare audit or any other medical payor audit in the Houston area, elsewhere in Texas or anywhere else across the country, don’t hesitate to contact us.