OIG: CMS Did Not Always Resolve Audit Recommendations

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Original story posted on: January 23, 2019

CMS audit performance gauged in HHS OIG announcement. 

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 this week 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.”

 

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Mark Spivey

Mark Spivey is a national correspondent for RACmonitor.com, ICD10monitor.com, and Auditor Monitor who has been writing and editing material about the federal oversight of American healthcare for more than a decade. He can be reached at mcspivey@hotmail.com.

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