On October 6, 2008 CMS announced its intent to aggressively enhance its efforts to find and prevent waste, fraud and abuse in Medicare. In particular, CMS indicated that it intends to work directly with beneficiaries to insure that they are properly receiving the durable medical equipment and home health services for which Medicare was billed and that the items or services are medically necessary. CMS also indicated that it will be taking additional steps in Florida, California, Texas, Illinois, Michigan, North Carolina and New York to fight fraud and abuse in the home health setting. Nationally, CMS will be implementing further medical review procedures by recovery audit contractors (RACs) in an effort to identify improper payments. As in the past, these RACs will be paid on a contingency basis.