CMS improperly measuring outcomes, report claims

Share this content:

So far, some providers have been put through a wringer without enough verification that it's been worth it, according to a new Government Accountability Office report. 

GAO investigators say the Centers for Medicare & Medicaid Services has not been thoroughly assessing how well zone program integrity contractors (ZPICs) are contributing to Medicare anti-fraud efforts.

ZPICs are charged with investigating potential Medicare fraud and as a result, can wreak havoc by requiring extra documentation and other time-consuming tasks. There is also the potential that significant penalties could be imposed on providers.

While CMS evaluates it contractors adequately, the GAO says the agency should do more to ensure that what ZPICs are doing truly supports fraud-prevention efforts. 

Report authors say CMS should better gauge its number of administrative actions, and the agency should better track whether the contractors are acting quickly enough against suspected fraudsters.

ZPICs were established in 2008 but have been thrust into the spotlight recently due to a concerted rise among multiple auditing efforts by the government to verify provider billing claims.