Recovery Audit Contractor Services

The Texas Health and Human Services (HHS) Office of Inspector General (OIG) is seeking a qualified Contractor to perform all recovery audit review services as described in 42 U.S.C. § 1396(a)(42)(B), 42 CFR Part 455 Subpart F, Texas Government Code Section 544.0504, and 1 TAC § 354.1451, which require states to contract with a Recovery Audit Contractor (RAC) for the purpose of identifying Medicaid Underpayments and Overpayments (also referred to as “Improper Payments”) under the Medicaid state plan and any waiver of the Medicaid state plan, including Fee for Services (FFS) and Managed Care Organizations (MCO).

Pursuant to Section 5 of House Bill (HB) 142, Texas’ 89th Legislative Session (2025), which amends Texas Government Code Ch. 544.054, the RAC program has expanded to include both fee-for-service (FFS) and managed care. Accordingly, the Contractor will perform federally required RAC function to detect, identify improper payments (overpayments and underpayments) and to recoup overpayments for items or services defined under the Medicaid State Plan or a waiver of the Medicaid State Plan.