"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.