July 20, 2015

HMS Holdings Loses New Jersey Medicaid Contract

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HMS Holdings Corp., the parent company of HMS, one of the nation’s largest Medicaid RACs, announced on Friday that New Jersey awarded its third-party liability (TPL) contract to Public Consulting Group of Boston. HMS said it would protest the awarding of the contract for the third-party liability services, a contract the HMS reports it has had with the state for 30 years. 

The fate of HMS’s role in the Medicaid RAC business is unclear. HMS is reported to be one of the largest Medicaid RAC auditors, serving more than 25 states. 

HMS Holdings’ wholly owned subsidiary, HealthDataInsights (HDI), challenged the Centers for Medicare & Medicaid Services (CMS) contract policy in April 2014, objecting to the CMS provision that recovery auditors would have to wait until the second level of appeal had been exhausted before receiving a contingency fee. HDI is vying to become a primary recovery auditor (RA), but those efforts were thwarted last year, when the Government Accountability Organization (GAO) rebuffed the protest filed by HDI over the provision.

There also was a lawsuit involving CMS and CGI, another RAC, over reimbursement rates, models, and approaches. Although the lawsuit was resolved in favor of CMS last summer, CGI immediately appealed, causing further delays and the postponement of a full restart of the RAC program.

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Chuck Buck is the publisher of RACmonitor and the executive producer and program host of Monitor Mondays.

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Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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