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

Related Articles:
Medicare Fraud Strike Force Operations Lead to Charges Against 53 Doctors, Health Care Executives and Beneficiaries
OIG: CMS anti-fraud efforts failing for lack of prompt claims analysis
CMS announces RAC contractor choices

Suggested Articles

Presidential candidate Kamala Harris wants to get rid of the tax break drug companies get for DTC ads

Healthcare software company Phreesia closed its first day of trading as a public company Thursday about 40% above its set price.

Growing the biosimilar market could lead to significant healthcare cost savings, according to a new report.