March 27, 2012

Targets of Audit Medicaid Integrity Contractors ‘Poorly Identified’

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Audit Medicaid Integrity Contractors (MICs), charged with finding provider overpayments, have been hindered by poorly identified audit targets, a March Office of Inspector General (OIG) report stated.

 

Out of $80 million identified by Review (MICs) as potential overpayments, just $6.9 million were confirmed as overpayments, according to the report that covers Jan. 1 through June 30, 2010. Of those that did not result in overpayments, 42 percent were completed with no overpayments or the reviews were discontinued by CMS and 39 percent were ongoing but unlikely to produce overpayments.

 

Audit MICs are given targets by CMS, which has received them from Review MICs. But two reasons for low rates of overpayments were data problems in the Medicaid Statistical Information System (MSIS) and misinterpreted program policy, the report stated.

 

In 19 percent of the cases in which no overpayments were found, payment was determined to be appropriate, according to the report.

 

For more information, find the OIG report at http://oig.hhs.gov/oei/reports/oei-05-10-00210.pdf.

 

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About the Author

 

Karen Long is the compliance product manager for DecisionHealth and oversees products that relate to fraud and abuse and HIPAA compliance for physician offices and home health agencies, and accreditation compliance for hospitals. In her almost four years at DecisionHealth, Karen also has been the compliance editor and a reporter for Home Health Line, nation's leading independent authority on home healthcare business, regulation and reimbursement.

 

Contact the Author

 

KLong@decisionhealth.com

 

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