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GAO to study redundant Medicare audits


By Rich Daly
Posted: June 26, 2012 - 5:00 pm ET
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The Government Accountability Office will study the extent to which Medicare providers are subject to redundant reviews by a range of contract auditors.

The review of Medicare's contractor programs aimed at rooting out fraud, waste and improper payments was ordered Tuesday by the congressional leaders of both parties who oversee the program (PDF).

Specifically, the GAO will review the extent to which the CMS coordinates investigations by Medicare administrative contractors, Medicare recovery audit contractors, zone program integrity contractors, program safeguard contractors and the comprehensive error rate testing review contractors.

The study of the Medicare contractors follows numerous complaints from providers regarding contractors' tactics and instances in which the private companies gave confusing or contradictory guidance.

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"In order for this contractor oversight to at once be effective at detecting improper payments and not unnecessarily burdensome to providers, it must be undertaken subject to a coherent strategic plan, consistent standards and active coordination," the members of Congress wrote GAO. "To this end, we ask that you undertake a study that focuses on coordination among contractor efforts and CMS efforts to oversee these contractors to ensure that they are working efficiently and effectively while guaranteeing that beneficiaries are receiving care to which they are entitled."

The GAO will evaluate how well CMS contractor coordination succeeds in avoiding overlap and duplication. Among the leading complaints that providers have raised about CMS contractors in recent years is that they often re-audit provider actions that were recently audited by other contractors. The GAO will seek to determine how often such repeat audits occur and identify steps the CMS can take to minimize them.

A Republican staff member on the Senate Finance Committee—the leaders of which requested the GAO study—told an audience at a Health Care Compliance Association meeting in May that senators had undertaken an informal inquiry into the actions of controversial healthcare auditing contractors, including zone program integrity contractors and recovery audit contractors.

The zone program integrity contractors, in particular, have drawn provider criticism for trying to assert investigative powers that even federal law enforcement agencies do not have.

The American Hospital Association, meanwhile, delivered a response to a letter from Senate Finance leaders seeking feedback from providers on the matter. The AHA raised concerns (PDF) that audits are redundant and often punish hospitals for billing mistakes in the same manner as if they were due to fraud or other abusive practices.

The AHA suggested efforts to eliminate the overlap and duplication of audits and reduce the power wielded by audit contractors and the U.S. Justice Department over payment policies, which hospitals argue sometimes interfere with clinical decisions.

“In addition, as the Finance Committee is looking at the goal of eliminating waste, fraud and abuse, it should be alert to how these laws are interfering with or inhibiting accomplishment of another of the committee's goals reforming the delivery system to advance quality, safety and efficiency,” the AHA's letter read.


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