A recent report from the Office of Inspector General (pdf) found that 81 percent of audits from Medicaid Integrity Contractors did not or were unlikely to identify overpayments when they first started.
The OIG looked at Audit and Review MICs' results for audits assigned between Jan. 1 and June 30, 2010. (In fiscal year 2010, CMS spent roughly $30.5 million on Review and Audit MICs, one of the initial years of the MIC activities.) Only 11 percent of assigned audits found overpayments for a total of $6.9 million, and the analysis suggested that problems with the data and analysis from Review MICs and CMS hindered Audit MICs' performance.
Of that $6.9 million, $6.2 million resulted from seven completed "collaborative audits" that involved Audit MICs, Review MICs, states and CMS. The OIG recommended that an increased use of collaborative audits that involves all pertinent parties could help prevent and identify more Medicaid overpayments.
The OIG looked at Audit and Review MICs' results for audits assigned between Jan. 1 and June 30, 2010. (In fiscal year 2010, CMS spent roughly $30.5 million on Review and Audit MICs, one of the initial years of the MIC activities.) Only 11 percent of assigned audits found overpayments for a total of $6.9 million, and the analysis suggested that problems with the data and analysis from Review MICs and CMS hindered Audit MICs' performance.
Of that $6.9 million, $6.2 million resulted from seven completed "collaborative audits" that involved Audit MICs, Review MICs, states and CMS. The OIG recommended that an increased use of collaborative audits that involves all pertinent parties could help prevent and identify more Medicaid overpayments.
More Articles on Hospital Overpayments:
OIG: CERT Payment Errors in 2009-10 Could Have Decreased $4B
AHA: More Than 70% of Hospitals Successfully Appeal RAC Denials
OIG Recommends CMS Provide Better Data to Identify Medicaid Fraud