CMS told to crack down better on improper Medicaid payments

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Collaborative audits have found "substantial" overpayments, GAO said, but still have barriers blocking states from participating.
Collaborative audits have found "substantial" overpayments, GAO said, but still have barriers blocking states from participating.

The Centers for Medicare & Medicaid Services needs to step up its involvement in states' Medicaid integrity programs in order to strengthen oversight and identify overpayments, according to a new federal watchdog report.

CMS oversees how states run their Medicaid integrity programs and supports fraud-fighting efforts through reviews, training and hiring contractors to audit providers. But the agency is still falling short in some areas relating to state's Medicaid audits, according to findings released by the U.S. Government Accountability Office on Monday.

The watchdog's report found that CMS lacks a system of collecting states' most “promising” Medicaid integrity practices and sharing them with other states. The agency's main approach, state program integrity reviews, are inconsistent in how they identify promising practices, the report said. GAO also chided CMS for failing to publish the best practices in a timely, easily accessible way.

In addition, the report took issue with CMS' collaborative audits, which pair up federal contractors and states. While the collaborative program has found “substantial” provider overpayments, barriers including staff burden or problems communicating with contractors have limited their impact and the number of states that choose to use them, GAO said. The report shows a wide range in the number of audits assigned in recent years, with 11 states conducting no audits and one state — Florida — was assigned more than 100 audits.

GAO recommended that CMS identify ways to address barriers that discourage states from participating in collaborative audits, and work with state officials to collect and share promising Medicaid integrity practices. The Department of Health and Human Services agreed with the recommendations.