In addition to conducting data analysis, it is the job of review Medicaid integrity contractors (MICs) to provide or recommend audit leads as well as to detect and prevent Medicaid fraud. However, between January 2010 and July 2010, they only conducted data analysis and, at the request of the Centers for Medicare & Medicaid Services (CMS), issued lists of providers ranked by the amount of their corresponding potential overpayments.

Trouble apparently now comes in threes!

First, just as providers were getting Medicare Recovery Audit Contractors (RACs, or now RAs) under control, Medicare Administrative Contractors (MACs) got thrown into the mix, snarling communication between RAs, MACs and providers. Second, the new Medicare Statement of Work (SOW) for Medicare RACs came out on Sept. 12, 2011, pushing RAs for claims review quotas. And third, we now have the final rule on Medicaid RACs that came out Sept. 16, 2011 and fully became effective on Jan. 1, 2012.