CMS contractors that work to prevent fraud and abuse in Medicare told the federal agency about 62 specific systemic issues allowing fraud to happen in 2009, yet the regulators had resolved only two of those issues by January 2011, according to a report.
CMS slow to act on fraud weaknesses: report
The HHS' inspector general's office reviewed the legally mandated reports of Medicare anti-fraud contractors and found the CMS was either slow responding to the concerns or, in many cases, nonresponsive to the reports, the report released Friday says.
Answering the inspector general's recommendations, now-former CMS Administrator Don Berwick wrote Oct. 26 that the agency will follow a recommendation to track its responses to all 62 vulnerabilities reported by the contractors, although he noted the “CMS cannot always resolve the vulnerabilities or resolve them as promptly as CMS would like due to various constraints.”
The financial impact of the vulnerabilities was not clear. The inspector general's office reported that the 21 vulnerabilities for which contractors listed financial-loss estimates totaled $1.2 billion. None of those 21 issues had been resolved as of the inspector general's deadline of January 2011, the report said.
Most of the vulnerabilities identified by fraud contractors related to coding and billing issues, such as payments allowed under incorrect billing codes, nonphysician services claimed inappropriately and the use of deceased providers' identification numbers.
Of the 62 separate vulnerabilities, the report said CMS had taken no significant action on 48 of them. Of the remaining 14 problems, two had been resolved and 12 were in the process of “significant action” toward resolution, the report said.
In his response letter, Berwick said the CMS is following “standard operating procedures” to actively manage the identified vulnerabilities on a monthly basis, but said following the recommendation of establishing timeframes to resolve the issues will be difficult.
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