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The RAConteur: Medicaid RAC Dash To The Finish Line

Posted by J. Paul Spencer, CPC, CPC-H in The RAConteur™

As I covered in a previous post, we now have a final rule for the Medicaid RAC program. A look at the calendar shows that with the implementation date of January 1, 2012, there are several states that have some work to do finalizing a contractor.

On the cusp of a slow week of RAC news, I thought I’d share information with the readers about the Medicaid RACs that have been assigned up to this point.

Two major players have emerged in the hunt for state Medicaid RAC contracts. HMS, a large player in state Medicaid integrity programs, has landed the states of Connecticut, Maine, Michigan, New Jersey, New Mexico, New York, Oregon, South Carolina and Tennessee as the primary contractor. In addition they have gained a contract as a subcontractor to the RAC program for the state of Colorado, which leads to the other emerging player.

CGI, the current Medicare RAC for Region B in the Upper Midwest, has landed Colorado as the primary contractor, as well as the states of Ohio and Pennsylvania. Judging from their work product in Region B thus far on the Medicare side, these three states, and potentially others, have no idea who just signed on the dotted line.

A company called Recovery Audit Specialists has been awarded the Medicaid RAC contract for the state of Arizona. I am unfamiliar with this company, and their company website provides little insight into who they have worked with in the past. I do notice that there are some flashy names on their executive advisory board, including two names with long-time ties to the federal government. It is hard to speculate whether they will receive additional contracts.

Thomson Reuters, a business information company, has been awarded the RAC contract for Indiana. PRGX, an Atlanta-based company who has focused on recovery audits in the past across numerous states, has been awarded the nearby state of Mississippi. Cognosante (as owner of a subsidiary formerly known as Fox Systems, or Prince, or something), another large player, has been awarded North Dakota. Finally, Goold Health Systems, a company more know for Medicaid pharmacy plan oversight, has been awarded the Medicaid RAC for New Hampshire.

I have conflicting information on the state of Delaware currently. When this is finalized, I’ll let the readers know. In addition, I know of a few other subcontractor relationships that are in existence that I’ll reveal at a later date.

It should also be noted that the states of Georgia, Maryland, South Dakota and Texas have all requested an exemption from the Medicaid RAC program. With the Supreme Court decision coming on the Affordable Care Act as a backdrop, it should be interesting to see if these are granted, and on what grounds.

I would imagine that announcements will come fast and furious over the next 2 1/2 months as we count down to the final implementation date. I would suggest to readers keep an eye on e-mails and news releases from their state’s Medicaid plan for future contract award information. In addition, if there are any awards that I am not aware of that have been handed out, please drop a comment below to help get the word out. No one acts alone.

The RAConteur will not appear next Wednesday, October 19th. The regularly scheduled posting will reappear on October 26th, just in time for Mischief Night.

3 Responses to “The RAConteur: Medicaid RAC Dash To The Finish Line”

  1. KL says:

    HDI has the KS Medicaid RAC contract.
    Keep the articles coming!
    Thank you.

  2. J. Paul Spencer, CPC, CPC-H says:

    YIKES! I have that one on my spread sheet, and forgot to include it. My humble thanks, Kristin!

  3. Hello. We just want to let you know that HMS is not the RAC vendor in Michigan. To the best of our knowledge, Michigan has not yet retained a RAC vendor. Please visit for the latest information on RAC procurement activity.

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