This week the Office of Inspector General of the U.S. Department of Health and Human Services (DHHS) released a report entitled “Early Assessment of Audit of Medicaid Integrity Contractors,” which found that 81% of the Centers for Medicare & Medicaid Services’ (CMS) pre-screened audits undertaken to fight waste, fraud and abuse in Medicaid were either unable or unlikely to identify overpayments during a recent six-month period.
 
The analysis found only 11% of assigned audits conducted from January 1 – June 30, 2010 by Medicaid Integrity Contractors (MIC) were completed with $6.9 million in overpayments identified, $6.2 million of which resulted from seven completed collaborative audits involving Audit MICs, Review MICs, States, and CMS. The remaining audits had not progressed enough to draw conclusions about likely outcomes.

Failure to find overpayments was blamed on the use of audit algorithms previously found ineffective, errors in the data, and the contractors who selected the providers to receive audits based on their likelihood to receive overpayments. The CMS spent $17.2 million on all such contractors in fiscal 2010. The report recommended the CMS increase its coordination with each state’s Medicaid officials.

The NCMS provides assistance and education to medical practices on how to prevent such audits.  Visit the NCMS Health Care Audit Resource Center for more information. PractEssentials, a NCMS Foundation initiative, provides consulting services designed to help your practice identify potential problems areas, evaluate options, and implement solutions. On April 25, PractEssentials will conduct a one-hour webinar on recovery audits. For assistance from PractEssentials or for more information, contact Franklin Walker, Director of Programs, at (800) 722-1350 ext 141.