Our Firm

What RACs Are and What They Do

Put simply, RACs are companies that contract with the Centers for Medicare and Medicaid Services (CMS) to audit invoices and bills against Medicaid and Medicare. Importantly, though, RACs provide a fee-for-service (FFS) audit and recovery program – they get paid based on how much they recover.

This gives them a strong incentive to find as much as they can, even if doing so would be a stretch of the imagination.

RACs audit bills against Medicare and Medicaid and look for overpayments and underpayments from the program – discrepancies between what was paid and what should have been paid. These can be the result of innocent inaccuracies or healthcare fraud. A few examples of the billing discrepancies that RAC auditors are looking for are:

• Payments by federal insurers for procedures that are not covered
• Medically unnecessary procedures
• Double billing
• Phantom billing, where the service was not actually provided or the patient does not actually exist
• Coding errors, where the wrong healthcare billing code was used for the procedure or service provided

If overpayments are discovered in the audit, RAC auditors will demand a recoupment of the amount overcharged. They may also mandate a pre-payment review of subsequent bills against Medicare and Medicaid, which can slow the payment process down to a crawl. If RAC auditors find a lot of errors, they can even extrapolate their findings over payments that were not actually audited, ballooning the audited healthcare company’s liabilities.

Finally, RAC auditors can refer cases of suspected healthcare fraud to CMS, the U.S. Department of Justice (DOJ), or the Office of Inspector General for the Department of Health and Human Services (HHS-OIG).

How Oberheiden P.C.’s RAC Audit Defense Team Helps Clients

Throughout the RAC auditing process, there are things that healthcare companies and professionals can do to protect their rights and their interests. A few of these are:

• Doing a pre-audit internal assessment to find what RAC auditors are likely to uncover
• Invoking any statutory exceptions that may apply to the healthcare provider’s business
• Ensuring that the audit does not exceed its legal scope of authority
• Intervening in the RAC audit by challenging any flawed methodologies its auditors are using
• Challenging the outcome of the audit
• Appealing an adverse outcome until it is overturned

Oberheiden P.C. has had success deploying these and any other defense strategies, depending on the specific circumstances of our clients.

Clients We Represent During the RAC Audit Process

At Oberheiden P.C., our RAC audit, appeals, and defense team has helped a wide variety of individuals and companies within the healthcare industry invoke their rights during RAC audits. Just a few of our clients have included:

• Medical professionals, like doctors and surgeons
• Medical facilities, like hospitals, out-patient clinics, and other providers
• Medical billing professionals
• Pharmacies
• Pharmaceutical companies
• Laboratories

Anyone who files a claim for compensation against Medicare or Medicaid stands the chance of being audited by RAC and needing our guidance and experience.

The RAC Audit and Appeals Team at Oberheiden P.C.

When Dr. Nick Oberheiden founded Oberheiden P.C. back in 2010, one of the goals was to get as many senior-level lawyers and experienced healthcare investigators into a single national firm to help healthcare providers across the country navigate this increasingly complex field of law.

Since then, our team has expanded significantly while still strictly adhering to the original goal: There would be only senior-level personnel at Oberheiden P.C.

All of our attorneys have numerous years of experience in healthcare fraud and protecting their clients during the RAC auditing process. They have extensive experience at every stage of this process, from internal auditing to the audit itself to the appeals process, which can take the case all the way to a federal courtroom.

Many of our lawyers and investigators also have numerous years of experience within some of the same federal agencies that can become involved in RAC audits, like CMS, the DOJ, the HHS-OIG, and even the Federal Bureau of Investigation (FBI).

Together, these senior lawyers and agents operate out of Oberheiden P.C.’s law offices across the country. While the firm is headquartered in Dallas, Texas, there are satellite offices in most major cities in the U.S., so no matter where you are, there are experienced RAC audit defense personnel from Oberheiden P.C. nearby.