Medicaid Recovery Audits
PRGX is the world’s largest recovery auditing firm. We help clients in Medicare and Medicaid identify and recover healthcare funds lost to billing or coding errors, coverage issues, fraud or abuse, third party liability or unnecessary medical procedures.
How PRGX differs from other RACs:
We have wide exposure to the issues and policies of various states, as well as to trends to look for in state Medicaid audits. We also designed and implemented one of the first state Medicaid programs in one of the largest states in the southern United States.
We pioneered the recovery auditing industry some 40 years ago, and no other company has more experience doing the work you need done. We have the financial, technical and clinical experts required to hit the ground running.
Recovery audits don’t have to be tough on your providers. And they shouldn't. We've learned how to audit with accuracy and recover money effectively, without causing provider abrasion.
Every year billions of dollars are wasted due to the complex maze of services, providers, procedures, and policies in the healthcare industry. Money continues to fall through the cracks despite limits, exclusions, and other checks and balances that have been put in place. Thankfully, that money can be recovered with PGRX.
Read more about our Healthcare experience or contact one of our healthcare team members today.
Meet The Team
Carlis E. Faler
Director Client Service, State Government
Carlis joined PRGX in the spring of 2011 and is responsible for healthcare business development and contract management for state government... More »
Case Studies
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Healthcare Recovery Audit Case Studies
As part of the CMS demonstration project, PRGX recovered $318 million for CMS from providers in California alone. More »
