Revenue Cycle

Recent OIG reports show critique on CMS' processes and programs

Recovery Auditor Report, May 17, 2012

During the past few months, there have been a number of Office of Inspector General (OIG) reports released that seem to question some of CMS’ audit programs and perhaps find them lacking. 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 occurring 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.

Audit MIC performance

One such report is an early assessment of the efforts of Audit Medicaid Integrity contractors (Audit MICs) 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.

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