The two unsuccessful bidders were PRG-Schultz and Viant. As a result of the protest they were able to come to an agreement. The settlement of the protest designated both to be able to serve as subcontractors to one of the chosen RACs. In 2009 the protests were settled and the program resumed.
Under sections 1833(e), 1842(a)(2)(B), and 1862(a)(1) of the Social Security Act, it is a requirement for the Centers for Medicare and Medicaid Services (CMS) to protect the Medicare Trust Fund against possible threats of fraud due to improper payments and must take corrective actions. In order for CMS to meet this requirement they must contract with Medicare Contractors. They work closely with Part A and Part B Medicare Administrative Contractors (A/B MACs), Durable Medical Equipment Medicare Administrative Contractors (DME MACs), and Fiscal Intermediaries (FI).
In the past CMS worked with twenty-three Fiscal Intermediaries and seventeen carriers across the nation. Their role was to process Medicare Part A and B fee-for-service claims. In order to make Medicare's administrative systems more efficient, competitive, and performance based CMS now contracts with ten A/B MACs, whom cover various regions across the country. The goal of the medical review program is to identify and address coverage and coding billing errors made by providers. In order to achieve this goal Medicare Contractors use data analysis and evaluation of information to identify possible billing and coding errors made by providers. They review Comprehensive Error Rate Testing (CERT) data, RAC vulnerabilities, and take action to prevent and address identified errors. Also, they publish a Local Coverage Determination policy to help provide guidance to the public and medical communities about which and when services and items will be covered by Medicare. As well as publishing educational articles that relate to the medical review process.