A new report by the Office of the Inspector General reveals during the Recovery Audit Contractor Demonstration period from March 2005 to March 2008 in Florida, California and New York that two rehabilitation service providers were referred to the Centers for Medicare and Medicaid Services (CMS) for possible fraud.
The RACs are not responsible for reviewing claims for fraudulent activity only for identifying improper payments.
The two referrals involved rehabilitation service providers and both involved suspected alterations of medical records after the services were rendered.More Medicare audit resources are found here.
According to the RAC referral letters sent to CMS, the RAC had no contact with the providers in reference to the allegations and continued to complete its complex and/or automated, postpayment review of the providers.
If CMS had determined that the referrals were potentially fraudulent, the RAC should have ceased its review of these claims.