Medical Audit Advocacy

Medical Audit Advocacy

The PAI endorses the Fair Medical Audits Act of 2015, which was introduced by U.S. Representative George Holding (R-NC).  Supporting materials can be accessed below:


About HR 2568

HR 2568 Would strengthen the program as follows:

  • Make every stage of the audit process more transparent;
  • Establish more rigorous qualifications for RAC officials performing claims reviews;
  • Increase accountability of RACs for inaccurate findings;
  • Establish incentives for RACs to educate providers on common mistakes in coding;
  • Prohibit the claw back of alleged over-payments until after a decision at the ALJ level of appeal;
  • Promote more targeted documentation requests by RACs;
  • Require a sound extrapolation formula for determining over-payment amounts;
  • Shorten the "look-back" period from 4 years to 2 years.


History of PAI Medical Audit Advocacy

PAI has worked for several years to secure fairer practices within the RAC audit program:

PAIl will continue to support state medical associations' efforts to secure fairer audit practices in Medicaid and in the commercial insurance market through state legislative and regulatory initiatives.