Virginia selected a recovery audit contractor with experience in the newly authorized fraud detection and prevention program for Medicaid.
The state awarded a three-year Medicaid RAC contract to HMS, the New York-based wholly owned subsidiary of HMS Holdings Corp. The contract has three one-year renewal options, according to an HMS news release.
The company will audit in-state and out-of-state providers participating in the Virginia Medicaid program to identify underpayments and overpayments for the Medicaid and Children's Health Insurance programs. Payments to the RAC will consist of "contingency fees"—a percentage of the overpayments or underpayments it identifies through its review of post-payment claims.
The Patient Protection and Affordable Care Act required each state to establish by Dec. 31, 2010, a Medicaid RAC program that contracted with at least one audit firm, according to the final rule implementing the provision (PDF).