New CMS Recovery Audit Contractor and Medicaid Integrity Contractor Audits

Preparing for RACs and MICs and Appealing Unfavorable Findings

Recording of a 90-minute CLE webinar with Q&A

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Conducted on Thursday, May 21, 2009

Course Materials

This seminar will review how Recovery Audit Contractor audits and Medicaid Integrity Contractor audits are being deployed, the current Medicare and Medicaid enforcement environment, and best practices to prepare for the audits and defend against or appeal unfavorable findings.


The Centers for Medicare and Medicaid Services (CMS) is intensifying its pursuit of fraud, abuse and waste in federal healthcare programs. Most recently, CMS hired contractors to educate Medicare and Medicaid providers, review provider actions, audit claims and identify overpayments.

Recovery Audit Contractor (RAC) audits focus on Medicare Parts A&B claims. Between 2005 and March 2008, RAC auditors identified and collected more than $1 billion in improper Medicare payments. RAC audits will move forward in a number of states in early 2009.

Simultaneously with the RAC audits, Medicaid Integrity Contractors (MIC) are auditing individuals and organizations providing Medicaid services. MICs are currently underway in two regions of the country. Auditors are expected to perform 200 provider audits per month by May 2009.

Listen as our panel of healthcare attorneys explains the current Medicare and Medicaid enforcement environment, how RAC and MIC audits are being used to stamp out fraud, abuse and waste, and strategies for preparing for audits and defending against or appealing unfavorable findings.



  1. Current Medicare and Medicaid enforcement environment
  2. Recovery Audit Contractor Audits (RACs)
    1. Lessons learned from RAC demonstration project
    2. Best practices to prepare for audit
    3. Provider appeals
  3. Medicaid Integrity Contractor Audits (MICs)
    1. Purpose of audits
    2. Who conducts audits?
    3. Providers subject to audit
    4. Provider selection process
    5. Best practices to prepare for audit
    6. Provider appeals


The panel will review these and other key questions:

  • How are RACs and MICs being used to identify and curtail wasteful spending in the Medicare and Medicaid programs?
  • What are the most common mistakes that result in Medicare and Medicaid overpayment?
  • What steps should providers take to ensure that their Medicare and Medicaid claims will withstand heightened CMS scrutiny during audits?
  • What strategies should counsel for providers employ to defend against unfavorable audit findings and prepare for appeal?


Paula G. Sanders
Paula G. Sanders

Post & Schell

She represents clients on Medicare and Medicaid survey and certification, compliance, and fraud and abuse issues. She...  |  Read More

Danielle Trostorff
Danielle Trostorff

Baker Donelson Bearman Caldwell & Berkowitz

She advises clients on health care regulatory matters including Medicare/Medicaid reimbursement, corporate compliance,...  |  Read More

Steve Lokensgard
Steve Lokensgard

Special Counsel
Faegre & Benson

He assists healthcare clients with a variety of claims appeals and compliance matters, including preparation for and...  |  Read More

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