Medicaid Recovery Audit Contractor (RAC) - RFP

South Carolina’s Department of Health and Human Services is seeking a qualified contractor to serve as the Medicaid Recovery Audit Contractor (RAC). The contractor will conduct post‑payment claim audits, identify overpayments, and ensure compliance with federal and state Medicaid regulations. This effort supports the state’s goal of recovering improper payments and improving Medicaid program integrity. • Perform detailed audits of Medicaid claims after payment, focusing on eligibility, medical necessity, and proper coding. • Deliver comprehensive audit reports, recovery recommendations, and data analytics to the agency. • Meet all statutory deadlines, adhere to confidentiality and security requirements, and maintain ongoing communication with agency staff.