CMS’ contractors may duplicate audits: GAO
The CMS’ audit contractors may overlap duties and hammer hospitals with multiple reviews of the same payment claims, according to a Government Accountability Office report that corroborates provider concerns.
Although the CMS reportedly has systems in place to prevent contractors from conducting duplicative audits, the GAO said the CMS’ oversight measures are not sufficient or reliable.
The GAO looked at recovery audit contractors, Medicare administrative contractors, zone program integrity contractors and comprehensive error rate testing contractors.
The GAO concluded that post-payment Medicare reviews are essential to reduce waste in the program, but that the CMS should take steps to “improve the efficiency and effectiveness of its contractors’ efforts.”
Namely, the agency should monitor its recovery audit database to ensure all contractors are submitting accurate, complete data, and it should routinely assess the auditors so they are not overlapping duties or overburdening providers.
The CMS said it agreed with the rec- ommendations and it would address them. The American Hospital Association said it supported the GAO’s conclusions. The American Coalition for Healthcare Claims Integrity, a group representing the contractors, said the oversight programs should be refined based on provider and auditor feedback.
Earlier this month, the CMS allowed the recovery audit contractors to restart some reviews of hospital claims. The program had been on hiatus since June 1, when the companies’ audit contracts expired.
CMS’ oversight measures are not sufficient or reliable.