OIG may tighten Medicare, Medicaid auditing programs

Providers are just beginning to get adjusted to the idea that they're facing far more auditing scrutiny, most notably from the RACs. Now, it's possible things will get a bit tougher yet, with the HHS Office of the Inspector General reviewing CMS's Medicare and Medicaid auditing programs.

Starting next year, the OIG will review how several Medicare and Medicaid auditing programs are going, as specified in the 2010 work plan. In addition to reviewing CMS's control of the RAC program, it will look at cases referred to CMS, processing of referral and training of national RACs.

The OIG will also take a look at the Medicaid Integrity Program to see if states are doing a good job of managing risks from the agency level on down. This includes how states handle screens for improper payments, how providers and/or payment types are targeted for audits, and whether improper payments are properly reported to CMS.

In short, folks, the whole audit thing may get worse before it gets better. So brace yourselves...

To learn more about the OIG's plans:
- read the OIG report here

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