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April 16, 2014

Recovery Audit Program

The goal of the Recovery Audit program is to identify and reduce improper payments made on claims for services provided to Medicare beneficiaries. All providers, including home health and hospice providers, may be subject to claims review by a RAC.

Recovery Auditors (formerly known as Recovery Audit Contractors or RACs) are divided into four jurisdictions, and are separate from the contract that CGS has to processing Medicare claims. The four recovery auditor jurisdictions and their corresponding states are listed below.

RAC States
Region A: Performant Recovery CT, DE, DC, ME, MD, MA, NH, NJ, NY, PA, RI, and VT
Region B: CGI Federal Inc IL, IN, KY, MI, MN, OH, and WI
Region C: Connolly, Inc. AL, AR, CO, FL, GA, LA, MS, NM, NC, OK, SC, TN, TX, VA, WV, Puerto Rico, and US Virgin Islands
Region D: HealthDataInsights AK, AZ, CA, HI, ID, IA, KS, MO, MT, ND, NE, NV, OR, SD, UT, WA, WY, Guam, American Samoa, and Northern Marianas

For additional contact information, refer to the "Recovery Auditor Contact InformationExternal PDF" link on the CMS website. Each recovery auditor will publish the issues they are selecting. All issues for review by the recovery auditor are approved by CMS, and posted to the Recovery Auditors websites prior to the review being conducted.

Additional Resources

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