CMS struggles to monitor Medicare contractors due to inaccurate data

Medicare contractors monitor hospitals and other healthcare organizations for fraud, but who monitors the contractors? The Centers for Medicare & Medicaid Services (CMS) does but ineffectively, suggests an Office of Inspector General (OIG) report, released Thursday. Federal health officials have failed to adequately supervise fraud contractors for more than a decade, reported the Associated Press yesterday.

Although CMS has updated the fraud contractor system, problems still persist. The workload data that CMS uses to oversee the Zone Program Integrity Contractors is inaccurate and inconsistent, according to the OIG report. OIG called on CMS to create effective oversight of the contractors by clarifying workload definitions, performing timely review of data, using and reporting workload statistics in contractor evaluations, and finally, ensuring that contractors have access to all the necessary data to carry out their work in identifying potential fraud and abuse. Article