Tuesday, August 26, 2014

GAO Releases Medicare Program Integrity Report

Dianne De La Mare

The US Government Accountability Office (GAO) has released a report, Medicare Program Integrity: Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Postpayment Claims Reviews, which specifically recommends that the Centers for Medicare & Medicaid Services (CMS) take actions to improve the efficiency and effectiveness of its contractors’ post payment review efforts including providing additional oversight and guidance regarding data, duplicative reviews and contractor correspondence. These are all issues that AHCA staff have discussed with both GAO and CMS in the past. 

The GAO reports that CMS’ current duplication reduction efforts are insufficient, as the Recovery Audit Data Warehouse, used to track recovery auditor (RA) activities, is not designed to provide information on all possible duplication and the data is not reliable. Communication between CMS and RAs also is flawed and the RA communication sent to providers is unclear and does not always outline the CMS requirements. 

Lastly, CMS coordination strategies should be improved. Currently, CMS has strategies in place to coordinate contractors activities; however, these strategies have not incorporated plans to increase consistency among the various contractors.

To obtain a copy of the full report go to http://gao.gov/products/GAO-14-474.

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