The main tools for detection of fraud and abuse were traditionally through whistleblowers who took information of a suspicious practice to the government.  This tool is still used, but electronic audits and monitoring are now playing a large role in fraud detection.  Usually, with either type of investigation you won’t know you are under investigation until the government unveils its case against you.  For some groups this is after many years of investigation and evidence collection.  With electronic means to review your claims for up to the last 10 years the risks are very high for anesthesia providers

The RAC program was started after a successful Medicare demonstration program that contracted with outside companies to find overpayments.  RACs are feared and rightly so, they are data mining companies rewarded for finding money.  The government incentivized the auditors by rewarding them with a percentage of the money collected. After the pilot project started, Medicare agreed to reward the RAC for finding underpayments along with the overpayments.