CMS must improve on pay errors, GAO report recommends
The CMS needs to do a better job of addressing and promptly correcting service-specific errors that result in improper payments discovered through its Recovery Audit Contractor program, the Government Accountability Office recommended in a report. The RAC program allows third-party auditors hired by the CMS to keep 9% to 12.5% of provider payments they identify as improper. The program was pilot-tested in several states from March 2005 to March 2008, recouping more than $992 million in overpayments to providers. The CMS’ goal is to have a permanent program operating in all 50 states this year, with four contractors each having jurisdiction for one-quarter of the country. What was missing from the demonstration project and in the planning for the national program was an adequate process for taking corrective action or sufficiently monitoring or controlling these types of errors or “vulnerabilities,” the GAO stated. The watchdog agency recommended that the CMS appoint personnel to evaluate and swiftly address these service-specific errors. The CMS agreed with the GAO’s recommendations.