Health Information Management

News: OIG makes recommendations to improve Recovery Auditor oversight

CDI Strategies, September 12, 2013

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Although Recovery Auditors have identified more than a billion dollars in inappropriate payments, CMS needs to do more to improve its oversight of the program, and target potential instances of fraud identified by the program, according to an August report from the Office of the Inspector General (OIG).

The OIG used information from the Recovery Auditor “data warehouse” from fiscal years (FY) 2010 and 2011, examined information regarding improper payments which exceeded $500,000 resulting from a specific issue, and gathered Recovery Auditor performance evaluations and metrics. It found that while CMS took corrective action to address the majority of the vulnerabilities it “did not evaluate the effectiveness of the[ir] actions.”

The OIG recommended CMS:
  • Take action on vulnerabilities and evaluate effectiveness of corrective actions already implemented
  • Ensure Recovery Auditors refer potential fraud cases
  • Review and take timely action on reported potential fraud
  • Develop additional performance evaluation metrics to improve Recovery Auditor performance



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