Health Information Management

News: Review Medicaid Integrity Contractors identify $282 million in potential overpayments

CDI Strategies, March 1, 2012

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Review Medicaid Integrity Contractors (MICs) completed 81% of their CMS assignments resulting in potential $282 million in possible recoveries for Jan. 1, 2010, to June 30, 2010, according to a February OIG report.

Review MICs find high-risk areas and flag providers with abnormal billing practices and turn these targets over to audit MICs who filter the list, select target areas, and essentially narrow the search. According to the OIG, the review MIC assignments resulted in 114 accepted reports, which identified 113,378 unique providers with $282 million in potential overpayments which CMS then filtered, selecting 244 audit targets with $39.8 million in potential overpayments.
 
The OIG indicated that missing and inaccurate data hindered the MICs ability to complete data analysis and found that states invalidated more than one-third of sampled potential overpayments from assignments.



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