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Pursuant to forty two U.S.C. § 1395ddd and the RAC Statement of Work, RACs are prohibited from selecting claims at random to overview. As a substitute, RACs use proprietary data evaluation techniques” to determine claims more likely to contain overpayments, a process generally known as targeted assessment.” A results of RACs partaking in these targeted reviews” is that certain types of claims and certain provider sorts may even see extra RAC auditing activity than others. For example, throughout the RAC demonstration program, 85 % of the alleged overpayments recognized and collected arose from inpatient hospital claims; 4 % arose from outpatient hospital claims; and the remaining eleven % arose from inpatient rehabilitation facility claims, skilled nursing facility claims, doctor claims, sturdy medical tools claims, and different sorts of claims.
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