GAO: CMS Database Not Stopping Duplicate Payment Audits

August 15, 2014 in News

A CMS database used to track audit contractors is not sufficient enough to ensure duplicate audits are not being conducted, according to a report released Wednesday by the Government Accountability Office, Health Data Management reports.

Report Details

According to the report, the database used to track audit activities — called the Recovery Audit Data Warehouse — was not created to provide all possible information on potential duplications. In addition, the report stated that the database does not provide reliable data because contractors do not consistently input data about the reviews they conduct. Because of these lapses, the report stated that:

  • The database does not always provide accurate information about excluded claims; and
  • The database is not always effective in preventing contractors from conducting duplicative claims reviews (Slabodkin, Health Data Management, 8/14).

The report stated, “CMS requires its contractors to include certain content in post-payment review correspondence with providers, but some requirements vary across contractor types and are not always clear, and contractors vary in their compliance with their requirements” (Al-Faruque, The Hill, 8/13).

In addition, the report found that CMS has not provided enough guidance to make sure that work is not duplicated between the four different groups that audit improper payments. Those groups are:

  • Comprehensive error rate testing contractors, which are responsible for reviewing claims to determine Medicare’s annual improper payment rate;
  • Medicare administrative contractors, which pay and process claims;
  • Recovery audit contractors, which look at payments that have not already been reviewed by other contractors; and
  • Zone program integrity contractors, which look into cases of potential fraud (Young, CQ HealthBeat, 8/13).

Recommendations

GAO recommended that CMS improve its contractor oversight and issue guidance on auditor data, contractor communications and duplicate reviews (The Hill, 8/13). It added that CMS must do more to monitor the database to ensure that contractors are submitting required information (Health Data Management, 8/14).

According to GAO, CMS agrees with the suggestions and is working to put them in place (The Hill, 8/13).

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