HHS watchdog says MACRA challenged by doc confusion, weak fraud protections

HHS' Office of Inspector General said in a report Thursday that implementation of MACRA still faces challenges because of doctors' confusion about the program, and it remains at-risk for fraud.

In a 30-page report, the OIG said that although clinicians are by-and-large aware of the Quality Payment Program, many are still uncertain about the technical details of the program, including how to report and submit data. The watchdog agency said without sufficient technical assistance from the CMS, clinicians "may struggle to succeed under the Quality Payment Program or choose not to participate." The agency also said the CMS has yet to develop and implement a "comprehensive" integrity plan for the Quality Payment Program that would protect it from fraud or improper payments. The program is particularly vulnerable to fraud because it relies on clinicians to submit their own data. "Safeguarding the validity of MIPS data and the accuracy of QPP payment adjustments is critical to ensure that these payments are based on clinicians' actual performance," the OIG said. In its recommendations, the OIG said the CMS should implement safeguards into the program that will ensure data can be consistently verified. The CMS said in response to the OIG that it's in the "early stages of developing an oversight plan for QPP data." The CMS also said it will continue outreach efforts to clinicians, and they are prepared to provide more technical assistance as clinician participation progresses. One unnamed CMS official told the OIG, "The tone and tenor of the types of questions the contractors are receiving will change from 'What is this?' to 'How do I do it?' So, (the amount) of hands-on, customized technical assistance (provided by contractors) is likely going to increase as clinicians move beyond their initial awareness of the program." The OIG also commended the CMS for improvements it has made in the last year to improve IT systems so it can conduct key provisions of MACRA, such as data submission, calculation of MIPS final scores and payment adjustments.