BC Advantage - 2009 Issue 6

How RAC Preparation and Your Compliance Plan Can Work Together

Background Different from other initiatives in the past, whether it be IL-372, Lab Audits, Evaluation and Management documentation or old fashioned fraudulent/abusive activities, etc... where a whistle-blower (disgruntled employee) was the catalyst for a long investigation (with much paperwork to review/audit/debate) to validate a payback, the Government is now using very powerful data mining technologies and capabilities to identify billing/payment abnormalities or "outliers" (a scary compliance term in some parts of the country) via their identified RAC Contractors, who happen to be directly incentivized to find overpayments. Thus, what was previously a long, drawn out process (remember "shadow audits")...

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