Watchdog: CMS should monitor Recovery Audit Data warehouse

A new Government Accountability Office report recommends sweeping government reforms that would mitigate fragmentation and duplication of a number of Medicare and Medicaid programs.

In his 34-page report, U.S. Comptroller General Gene Dodaro recommends the Centers for Medicare & Medicaid Services monitor the Recovery Audit Data Warehouse and offer better guidance on contractors' responsibilities. The report says that there should be more direction on contractor responsibility, and that the database can prevent duplicative reviews.

The report also suggests the government: improve coordination of the multitude of programs for serious mental illness; address duplication among Medicaid and the Veterans Administration on non-emergency medical transportation services; change Medicare's cost-based payment methods for certain cancer hospitals to save money; and hold states more accountable for reporting accurate and complete data on state Medicaid sources of funds.

The GAO's 2015 annual report identifies 66 new actions that executive branch agencies and Congress could take to improve the efficiency and effectiveness of government in 24 areas. GAO also identifies 12 areas where opportunities exist either to reduce the cost of government operations or enhance revenue collections.

Specific issues in the report related to long-term care include:

  • Programs for serious mental illness. Greater coordination of federal efforts is needed to help ensure that the eight federal agencies administering over 100 programs supporting individuals with serious mental illness are able to develop an overarching perspective in order to understand the breadth of programs and resources used.
  • NEMT program reform. Forty-two programs across six different federal departments provide non-emergency medical transportation (NEMT) to individuals who cannot provide their own transportation due to age, disability or income constraints. The GAO recommends that the Department of Transportation intervene to enhance coordination among NEMT programs at both Medicaid and the Department of Veterans Affairs.
  • Adjusting Medicare payments to certain cancer hospitals. The report advises Congress to consider changing Medicare's cost-based payment methods for certain cancer hospitals, a move that would generate $500 million in annual savings for the government.
  • Improved state Medicaid reporting. To potentially save taxpayers hundreds of millions of dollars, CMS should ensure that states report accurate and complete data on state Medicaid sources of funds so that it may better oversee states' financing arrangements that can increase costs for the federal government.