CMS Audit Performance Gauged in HHS OIG Announcement

By
Original story posted on: February 6, 2019

CMS squeaks by with B-plus in OIG audit.

If the Centers for Medicare & Medicaid Services (CMS) received a grade for its audit performance during the 2015 and 2016 fiscal years, it would have been about a B-plus, maybe waived up to an A-minus, according to an announcement made recently by the U.S. Department of Health and Human Services (HHS) Office of Inspector General (OIG).

When looking at timeliness during those years, however, CMS barely avoided flunking.

The federal agency did resolve 89.8 percent of 1,371 recommendations outstanding over that time frame, marking “significant progress” compared to prior years, but resolved just over two-thirds of those completed recommendations within the required six-month resolution period, the HHS OIG said in a statement.

“In addition, as of Sept. 30, 2016, CMS had not resolved 140 audit recommendations that were past due for resolution,” the statement read. “Some of the past-due recommendations had associated dollar amounts that totaled $138.6 million; others were procedural in nature.”

The poor review of CMS timeliness came with a caveat.

“Although CMS did not always issue management decisions and submit the related clearance documents within the required six-month resolution period, CMS did make progress in this respect (compared with the findings of our previous review) by significantly increasing the percentage of audit recommendations that were resolved in a timely manner and by significantly reducing both the total number and associated dollar amounts of unresolved audit recommendations that were past due for resolution,” HHS OIG said.

However, the federal healthcare oversight watchdog group somewhat ominously added that without resolving all audit recommendations in a timely manner, CMS “runs the risk of noncompliance with federal requirements and mismanagement of federal funds.”

“The prompt resolution of audit recommendations helps ensure that federal funds are effectively and efficiently used to carry out the activities for which they were authorized,” the HHS OIG statement read. “We recommended that CMS continue to follow its policies and procedures related to the audit resolution process, and enhance them where possible, and promptly resolve the 140 outstanding audit recommendations that were past due as of Sept. 30, 2016.”

HHS OIG noted that CMS has already concurred with its recommendations and described corrective actions that it had taken or planned to take.

“CMS stated that it would continue to assess and further refine its audit resolution process to ensure that recommendations are resolved within the required period,” HHS OIG said. “CMS also stated that it had already resolved 97 of the 140 open recommendations (with associated dollar amounts that totaled $109 million) and added that it expected to resolve the remaining 43 recommendations by early 2019.”

 

Comment on this article

Mark Spivey

Mark Spivey is a national correspondent for ICDmonitor.com, RACmonitor and ICD10monitor who has been writing on numerous topics facing the nation’s healthcare system (and federal oversight of it) for eight years.

This email address is being protected from spambots. You need JavaScript enabled to view it.

Related Articles

  • CMS Eliminates Reporting of Functional Limitation Codes
    CMS also has updated its therapy manuals, making elimination of FLR official. Many therapy providers, at hospital outpatient departments and private-practice clinics alike, were reluctant to stop submitting functional limitation reporting codes and impairment modifiers until they could see the…
  • The Hard Fact About ABNs in the ED
    Weighing the difficult decisions being made in the business of healthcare. Medicine has commonly been considered one of the most altruistic professions.  From long years spent in training to long hours spent caring for others and the perpetual drive to…
  • Physicians and the Opioid Crisis
    MAC to audit physicians who prescribe opioids. It is well-known to the medical community and to the general public that the opioid epidemic has taken too many lives. The causes are myriad (I outlined these in a KevinMD.com article in…