HMS (hms.com) is under contract with the Illinois Department of Healthcare and Family Services, Office of the Inspector General as Illinois’ Medicaid Recovery Audit Contractor (RAC), pursuant to Section 6411 of the Patient Protection and Affordable Care Act of 2010. Accordingly, HMS is authorized to audit provider payments and associated financial records to identify underpayment and overpayments, and recover any overpayments made to providers. HMS is currently working with HFS-OIG to develop all processes and approve target areas for review. The RAC program’s mission is to reduce Medicaid improper payments through the efficient detection and collection of overpayments, and the identification of underpayments.
To that end, this website provides information relevant to the scope of work to be completed by HMS on behalf of the Illinois Department of Healthcare and Family Services Office of the Inspector General and is intended to support the State in achieving its mission to reduce improper Medicaid payments in alignment with the Recovery Audit Contract.
The following is a high level step by step flow covering the general Recovery Audit Process. Once an audit is initiated, timelines and specific requirements to the audit will be communicated directly to each provider involved in that specific RAC audit scenario.
This section will provide you with a snapshot of the current and upcoming areas to be reviewed for RAC audit.
The Illinois RAC weekly findings webinar has been replaced with an on-demand version of the presentation. You can view the presentation here. The slide deck for this presentation can be found here.