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Medicaid audit advocacy engages states, CMS

February 03, 2015

By Craig Palmer

Washington — Medicaid audits in their various forms have become an issue of concern over the last several years.

State dental society and ADA advocacy of member concerns about the Medicaid audit process and RAC audits in particular have prompted regulatory activity in several states and ongoing policy discussions with the Centers for Medicare & Medicaid Services. One contractor participated in a panel discussion on audit compliance at ADA 2014 – America’s Dental Meeting.

Connecticut, Louisiana, Missouri, Montana and Washington are among states that have enacted or are considering legislation to regulate Medicaid audits, according to an ADA quarterly management report. “As the Affordable Care Act requires states to employ Recovery Audit Contractors (RAC), reports of aggressive and unfair audits of Medicaid dentist providers have increased,” the report said. 

The Virginia Dental Association and American Dental Association executive directors raised the RAC audit issue with the Centers for Medicare & Medicaid Services, Jan. 8.

“RAC audits are a significant concern for our members, for both enrolled Medicaid providers and those interested in becoming an enrolled provider,” the dental executives told CMS officials. “We believe education focused on compliance will be highly beneficial but would appreciate some additional guidance from [CMS officials] on the next steps. CMS has a number of resources available online but we believe further dissemination and tailoring would be good for our members.”

ADA staff will follow up with CMS Center for Program Integrity staff.