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Illinois RAC

a service of HMS


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.

Audit Process Overview

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.

  • Step 1: HMS receives data files from HFS-OIG to cover the look back period of three years from the dates of service.
  • Step 2: The data is reviewed by HMS in conjunction with State of Illinois policies and regulations prior to submission of audit scenarios to HFS-OIG for review and approval.
  • Step 3: HFS-OIG reviews the audit scenario and corresponding policies and regulations and either approves or denies the audit scenario.
  • Step 4: Upon arrival of the scenario by HFS-OIG, HMS initiates the audit protocol. Provider contact is initiated and the audit process begins.
  • Step 5: The documentation received from each provider is reviewed by HMS audit staff and a determination will be made.
  • Step 6: A notification of findings or a notification of no findings will be sent to the provider upon completion of the audit process.
  • Step 7: If a provider does not request reconsideration/appeal within timeframe allotted, recovery of funds will begin.
  • Step 8: HMS and HFS-OIG will review and analyze the results of the audit findings to determine if additional or updated provider outreach and education would be beneficial to the overall provider community.

Audit Process Overview

Illinois Audit Areas

This section will provide you with a snapshot of the current and upcoming areas to be reviewed for RAC audit.

  • Durable Medical Equipment Providers
  • Inpatient Hospital Services
  • Outpatient Hospital Services
  • Professional Services
  • Hospice
  • Ambulance
  • Long Term Care

Informational Documentation

IL RAC Overview Presentation (PDF)

Upcoming Events

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.


Contact Information

  • HMS Provider Services: 1.855.699.6292
  • HMS RAC E-mail: ilrac@hms.com