Health Information Management

OIG reports critique on CMS’ processes and programs

HIM-HIPAA Insider, May 22, 2012

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In recent months there has been a number of Office of Inspector General (OIG) reports released that seem to question some of CMS’ audit programs. It remains uncertain why the release of these audit reports have come within such a short window of time, but the fact that they are appearing should be an indication that CMS’ methods and processes are far from perfect. The following is a look at some of the recent OIG critiques of CMS programs.

Audit MIC performance

One such report is an early assessment of the efforts of Audit Medicaid Integrity contractors (MIC) to identify overpayments in Medicaid. The report, released on March 20, indicates that only 11% of the study-assigned audits were completed with findings of $6.9 million in overpayments, $6.2 million of which resulted from seven completed collaborative audits involving Audit MICs, Review MICs, states, and CMS. This leaves 81% of audits that the MICs were unable to or unlikely to identify any underpayments or overpayments. The OIG deduced that problems with the data used and analyses conducted by Review MICs and CMS to identify audit targets hindered the performance of the Audit MICs.

Click here to read more on the Revenue Cycle Institute blog.



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