The Michigan Department of Health and Human Services (MDHHS) posted a Medicaid Provider Letter on June 25, 2026, announcing that the Medicaid Recovery Audit Contractor (RAC) contract was awarded to Health Management Systems, Inc. (HMS). The contract runs through August 31, 2028, and will be overseen by the MDHHS Office of Inspector General.
The federal government requires states to have Medicaid RAC programs through which the contractors will audit claims. According to the 2026 Medicaid Provider L 26-36 letter, “HMS will approach the auditing of state provider services in two ways: automated and complex medical record reviews. Automated Reviews are audit algorithms that have gone through state specific billing and reimbursement analysis in which improper payments can be determined from claim data elements and well-established policy and rules. Complex Reviews are audit algorithms that have gone through state-specific billing and reimbursement analysis that cannot be automatically validated and require a medical record review conducted by qualified registered nurse reviewers, certified coding specialists, and physician peer review, as required.”
Providers selected for an audit will receive a letter from HMS with detailed instructions and contact information. Once the review is completed, providers will be notified of the findings of these audits and will have an opportunity to provide documentation for reconsideration and/or appeal if they disagree with HMS' findings.
Any questions regarding this Medicaid Provider L letter should be directed to HMS Provider Services at (844) 364-6108. You can also contact Stacey Hettiger at shettiger@msms.org.