OIG critiques deployment of Medicaid integrity contractors

The Department of Health & Human Services' Office of the Inspector General (OIG) concluded that Medicaid Integrity Contractors (MICs) are not being used to their full potential because they can only access incomplete data and cannot make specific recommendations as a result of the analyses they conduct, reported AHA News Now.

According to a study of MIC work during the first half of 2010, the MICs completed more than 80 percent of their assignments. However, they were constricted in recommending specific audit leads to the Centers for Medicare & Medicaid Services. Instead of being allowed to make recommendations about which organizations should be further scrutinized, they could only submit to CMS lists of providers ranked by the amount they may have received in claims overpayments.

Moreover, the MICs were hindered by inaccurate or missing CMS data. That led to the invalidation of more than one-third of potential overpayments by state Medicaid program officials.

The OIG recommended that CMS improve the data provided to MICs and require contractors to make audit recommendations based on the work they conduct.

For its part, CMS said it is taking action. 

"CMS is expanding the Medicaid Statistical Information System to include additional data elements important for detecting Medicaid fraud, waste and abuse," as a result of the report, according to the OIG.

To learn more:
- read the AHA News Now article
- read the OIG report