Tag: Recovery Audit Contractor (RAC)
Cotiviti takes cautious approach to new audits
December 12, 2025Liz Beaulieu, Editor
SOUTH JORDAN, Utah – Cotiviti, the new Recovery Audit Contractor (RAC) for Regions 3, 4 and 5, recently received approval from the Centers for Medicare and Medicaid Services (CMS) to launch five durable medical equipment (DME)-related audits. But industry experts say the contractor is taking a cautious approach before moving forward.
Cotiviti, which was awarded the contract in April, now has the green light to audit...
New RAC announces five DMEPOS-related audits
October 14, 2025HME News Staff
WASHINGTON - CMS has officially approved five DMEPOS-related audit projects under the new Medicare Recovery Audit Contractor (RAC), Cotiviti GOV Services, according to a bulletin from AAHomecare.
Cotiviti was awarded the contract for Regions 3, 4 and 5 in April. It is the contractor’s first time overseeing Medicare DMEPOS RAC reviews.
The new projects include:
Immunosuppressive drugs
Medical necessity and documentation requirements – A complex...
In brief: Feds convict CEO, Australia sues Philips, CMS awards new RAC
June 6, 2025HME News Staff
WASHINGTON – Federal authorities have convicted Gary Cox, 79, CEO of Power Mobility Doctor Rx (DMERx), for orchestrating a $1 billion Medicare fraud scheme involving false doctor orders for medically unnecessary equipment like braces and treatments. Cox and his co-conspirators misled seniors into providing personal information through deceptive advertising and offshore call centers, then used DMERx—a digital platform—to create fraudulent prescriptions. These orders were exchanged...
CMS awards RAC contracts to Cotiviti
June 4, 2025HME News Staff
WASHINGTON – CMS in April named Cotiviti GOV Services the new Recovery Audit Contractor (RAC) for Region 3, 4 and 5. These three contracts, awarded through a competitive procurement process, will support post-pay review of Medicare claims in these regions to efficiently identify and correct overpayments and underpayments made to health care providers with a focus on the quality, accuracy and transparency of reviews, the recovery of improper payments and the reduction of provider burden, Cotiviti...
In brief: Regulatory update, e-prescribing report, Lincare acquisition
February 18, 2022HME News Staff
WASHINGTON – CMS on Feb. 10 published a change request notifying the DME Medicare Administrative Contractors of the agency’s new national coverage determination for home oxygen therapy.
CMS notes the following changes are effective for claims with dates of service starting Sept. 27, 2021:
expansion of oxygen coverage for acute and chronic conditions;
expansion of coverage for short and long-term need (when hypoxemia exhibited);
the ability of the...
Regulatory update: DME MACs notified, RACs limited
February 15, 2022HME News Staff
WASHINGTON – CMS on Feb. 10 published a change request notifying the DME Medicare Administrative Contractors of the agency’s new national coverage determination for home oxygen therapy.
CMS notes the following changes are effective for claims with dates of service starting Sept. 27, 2021:
expansion of oxygen coverage for acute and chronic conditions;
expansion of coverage for short and long-term need (when hypoxemia exhibited);
the ability of the MACs...
Audits start to pile up
September 15, 2020HME News Staff
WASHINGTON - CGS, the DME MAC for jurisdictions B and C, will be conducting complex post-pay reviews for surgical dressings and knee orthoses, according to AAHomecare.
CGS will be reviewing A6196 and A6212, and L1833 and L1851. The DME MAC is conducting the reviews due to data analysis that showed “significantly above expected amounts.”
Surgical dressings and knee orthoses also ranked No. 5 and No. 9, respectively, in total CERT improper payment rates. The reviews will include only...
RAC notifies providers of reviews
August 21, 2020HME News Staff
WASHINGTON - Performant, Medicare's RAC, has notified providers by letter that, per authorization from CMS, it will resume certain medical review activities, according to the van Halem Group.
The notification says providers have an additional 30 days to submit discussion requests for review for result and initial findings letters dated Feb. 27, 2020, to March 27, 2020. It also advises providers to access the Provider Portal to review any claims pertaining to those dates.
Performant most...
RAC adds beds, manual wheelchairs to audits
February 7, 2020HME News Staff
WASHINGTON - The Recovery Audit Contractor (RAC) has received approval to audit hospital beds and manual wheelchairs, according to a bulletin from AAHomecare. The issue names are “Hospital Beds: Medical Necessity and Documentation Requirements” and “Manual Wheelchairs: Medical Necessity and Documentation Requirements.” These are both complex reviews and the RAC will be determining whether the items were reasonable and necessary based on the medical record. The RAC...
Audit round up: RACs cut checks, UPICs run roughshod
June 28, 2019Theresa Flaherty, Managing Editor
YARMOUTH, Maine - Nearly two years after Performant Recovery announced it would perform an underpayment review for Group 3 power wheelchair options, providers are receiving refund checks, says Andrea Stark.
Performant, the DMEPOS RAC, announced in May 2017 it would review wheelchair accessories, including seating systems, and seat and back cushions furnished in conjunction with codes K0848—K0864 for the six-month period of Jan. 1, 2016—June 30, 2016. The review was necessary because...