The cost of Medicaid fraud audits is five times more than the amount of overpayments they identify, according to a report from the Government Accountability Office.
The Medicaid Integrity Group, overseen by CMS, implements the National Medicaid Audit Program. There are three types of audits that can identify Medicaid overpayments: test audits, collaborative audits and audits based on Medicaid Statistical Information System data. The report says the majority of MIG audits were less than effective because they used data from the MSIS, which does not contain key elements like provider names.
"Since fiscal year 2008, a small fraction (4 percent) of the 1,550 MSIS audits identified $7.4 million in potential overpayments, over two-thirds did not identify overpayments and the remaining audits (27 percent) were ongoing," according to the report.
The typical amount of the potential overpayment for MSIS audits, $16,000, was also modest compared with amounts identified through test and collaborative audits, which can bring back $140,000 and $600,000, respectively.
MSIS audits accounted for 92 percent of those conducted from 2008 through February 2012. Collaborative audits accounted for 7 percent while test audits accounted for 2 percent.
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The Medicaid Integrity Group, overseen by CMS, implements the National Medicaid Audit Program. There are three types of audits that can identify Medicaid overpayments: test audits, collaborative audits and audits based on Medicaid Statistical Information System data. The report says the majority of MIG audits were less than effective because they used data from the MSIS, which does not contain key elements like provider names.
"Since fiscal year 2008, a small fraction (4 percent) of the 1,550 MSIS audits identified $7.4 million in potential overpayments, over two-thirds did not identify overpayments and the remaining audits (27 percent) were ongoing," according to the report.
The typical amount of the potential overpayment for MSIS audits, $16,000, was also modest compared with amounts identified through test and collaborative audits, which can bring back $140,000 and $600,000, respectively.
MSIS audits accounted for 92 percent of those conducted from 2008 through February 2012. Collaborative audits accounted for 7 percent while test audits accounted for 2 percent.
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