Relating to the Health and Human Services Commission's office of inspector general, the review of certain Medicaid claims, and the recovery of certain overpayments under Medicaid.

Contracts

• MCO Provider Agreements: Review "Indemnification" and "Overpayment Recovery" clauses immediately. The law allows the state to recover from the MCO; the MCO will contractually attempt to pass this liability (and potentially the RAC's contingency fee) down to the provider.
• Vendor Service Level Agreements (SLAs): Update agreements with third-party billing or release-of-information vendors. They must be contractually obligated to notify you of a RAC request within 24 hours to ensure you do not miss statutory submission deadlines.

Hiring/Training

• "Gatekeeper" Training: Train Health Information Management (HIM) and compliance staff to stop automatic processing of audit requests. They must perform a "Triage Check" before releasing data:
• 1. Is the claim less than 365 days old? (If yes, reject based on Sec. 544.0504).
• 2. Is the claim currently under MCO review? (If yes, reject based on "Double Jeopardy" provisions).

Reporting & Record-Keeping

• Centralized Audit Log: You must maintain a real-time log of all active audits by Claim ID. You cannot utilize the statutory defense against RAC audits without documented proof that an MCO is already auditing the specific claim.
• Credentialing Files: Maintain current proof of "Good Standing" from licensing boards for all professionals. This documentation is now the statutory rebuttal against OIG demands for fingerprint-based criminal history checks.

Fees & Costs

• Contingency Fee Exposure: RACs are paid a percentage of recovered funds. Expect an increase in technical denials and aggressive coding interpretations.
• Insurance: Verify that your Regulatory Billing E&O policy covers defense costs for multi-agency investigations, as the OIG now has expanded authority to share data with law enforcement.