OIG Plans to Review Medicare, Medicaid Auditing Programs

The OIG also plans to review claims from certain provider types that are "high risk" for submitting improper Medicaid claims. It will identify specific high-risk providers for review based on past Medicaid program work and Payment Error Rate Measurement (PERM) program error rates.

CMS' oversight of the Medicare and Medicaid Data Match Project (Medi-Medi) is also on the OIG's list for review. Medi-Medi seeks to improve the coordination of Medicare and Medicaid program integrity efforts by proactively identifying vulnerabilities or fraud and abuse that may have gone undetected if the data was analyzed separately. According to the Work Plan, the OIG plans to determine whether CMS "is meeting contractual requirements outlined in the Medi-Medi task orders." Task orders were in place for 10 states as of 2007.

Editor's note: For more on ZPIC auditing activities, consider attending the upcoming audio conference, "Zone Program Integrity Contractors: Learn Who They Are, What They Want, and How to Respond to a Review." In addition, for more on Medicaid Integrity auditing, take advantage of the upcoming audio conference, "Medicaid Integrity Contractor Audits: Know What to Expect and How to Prepare."