GAO urges changes to CMS program integrity efforts
AHA News Now
Dec 11, 2012
The Centers for Medicare & Medicaid Services should eliminate duplication and inefficiencies in the National Medicaid Audit Program, and strengthen its use of prepayment edits to prevent improper payments in the Medicare program, the Government Accountability Office said in separate reports released yesterday. GAO recommends that the Medicaid program merge review and audit contractor functions; use comprehensive reviews to better target audits; ensure reliable reporting of state program integrity recoveries; discontinue annual state assessments; and reevaluate and publish its return-on-investment methodology. The agency also recommends seven actions to strengthen CMS' use of prepayment edits to prevent improper payments in the Medicare program, with a focus on eliminating inconsistency across contractors and improving the use of automated edits. In comments to GAO, the Department of Health and Human Services said it generally agreed with the Medicare recommendations, and that CMS is revising its Medicaid integrity plan for fiscal years 2013 to 2017 to address duplication and inefficiencies. AHA Executive Vice President Rick Pollack said, "Hospitals suffer the burden and costs of duplicative and unnecessary reviews. These GAO reports reinforce hospitals' call for the agency to streamline and improve the work of its contractors."