Friday, November 8, 2013

OIG Releases Medicare RA Contractors Report

By Dianne De La Mare

The US Department of Health and Human Services, Office of Inspector General (OIG) recently released a report, Medicare Recovery Audit Contractors and CMS’s Actions to Address Improper Payments, Referrals of Potential Fraud, and Performance, which focuses on identifying problems with CMS’ actions to address improper payment vulnerabilities and oversight of its Medicare contractors.  According to the report, in FYs 2010-11, Medicare Recovery Auditors (RAs) identified half of all claims they reviewed as having resulted in improper payments, totaling $1.3 billion. 

CMS took corrective actions to address the majority of those vulnerabilities; but it did not evaluate the effectiveness of those actions.  As a result, high amounts of improper payment may continue.  CMS also did not take action to address the 6 referrals of potential fraud received from the RAs.  Finally, CMS’ performance evaluations did not include metrics to evaluate the RA performance evaluations and did not include metrics to evaluate RA performance on all other contract requirements. 

OIG recommends that CMS:  (1) take action on vulnerabilities that are pending corrective action and evaluate the effectiveness of implemented corrective actions; (2) ensure that RAs refer all appropriate cases of potential fraud; 3) review and take appropriate, timely action on RA referrals of potential fraud; and (4) develop additional performance evaluation metrics to improve RA performance and ensure that RAs are evaluated on all contract requirements.  To obtain a complete copy of the OIG report, click here.

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