OIG: Weak Medicaid claims data fails to recover overpayments

Missing or inaccurate Medicaid billing data is holding back contractors from pinpointing providers overpaid by Medicaid and therefore hindering recoveries, the Office of Inspector General reaffirmed its concerns about the weak results from Medicaid Integrity Contractors (MIC) in a report Monday.

The problems with the quality of data and analysis, conducted by review MICs and the Centers for Medicare & Medicaid Services, lead to poorly identified audit targets, the OIG said in the report. CMS assigned auditors to 161 targeted providers with a potential $33.5 million in overpayments. However, as of Feb. 1, audit MICs completed only 127 of them, worth $285,629 in overpayments. Thirty-four of the audits were never completed.

What's more, the OIG said an average of 10 months lapsed from the time CMS assigned the audits to when audit MICs reported their findings to CMS.

CMS, however, defended itself and said it is improving audit target selection by improving the quality of the data that MICs can access for conducting data analysis. CMS also redesigned its audit assignments approach by instructing audit MICs to focus on collaborative projects.

This isn't the first time that OIG has been critical of CMS, suggesting that the recovery programs are slow and ineffective. OIG last month also called on CMS to use a reliable methodology for adjusting the national Medicare fee-for-service error rate. OIG said if CMS overturned Comprehensive Error Rate Testing (CERT) denials in its error rate calculations, it would have decreased the estimated value of reported errors in 2009 and 2010 by approximately $2 billion each year.

For more information:
- here's the OIG report (.pdf)

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