Revenue Cycle

GAO study identifies strategies for CMS to reduce improper payments, offers Medicaid RAC program update

Recovery Auditor Report, March 24, 2011

A Government Accountability Office (GAO) study released March 9 identifies five ways in which GAO recommendations and recent laws, as well as other agency actions, can help CMS reduce Medicare and Medicaid fraud, waste, abuse, and improper payments.

Based on GAO reports from 2004 through 2010, the study found CMS should employ the following five strategies:

  • Strengthen provider enrollment standards and procedures
  • Improve prepayment claim review
  • Focus post-payment claims review on the most vulnerable areas and add additional recovery audit RACs
  • Improve contractor oversight
  • Develop a robust process for addressing identified vulnerabilities

Included in the study was a minor update on the status of Medicaid RACs. Fifty-five state Medicaid agencies have submitted plans for addressing the Medicaid RAC Patient Protection and Affordable Care Act (PPACA) provision as of February, CMS officials told the GAO. Fourteen states have asked for exceptions in part or in whole. CMS plans to make public its decisions on any exceptions granted, according to the GAO.

To view the GAO study, click here.

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