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OIG Uncovers Flaws in CMS Processes, Programs

James Carroll, for HealthLeaders Media, May 17, 2012

The other good news for providers is that this report shows that provider appeals are successful, which should add a little fuel to their fire, according to Mackaman.

"Providers should be encouraged by this report and continue to appeal denials when appropriate and cost-effective to do so," she says. "It also might not be a bad idea for providers to lobby their own local media and congressional members to make sure that this side of the story is also told."

CMS’s Medi-Medi program
Though it’s not a CMS audit program, the Medicare-Medicaid data match program (Medi-Medi program) was also reviewed by the OIG in a report released on April 17. This program enables program safeguard contractors and participating state and federal government agencies to collaboratively analyze billing trends across the Medicare and Medicaid programs to identify potential fraud, waste, and abuse.

In the report, the OIG analyzed data from 2007 and 2008 that was collected from CMS, PSC, State Medicaid program integrity agencies, and other federal and state agencies participating in the program. The review found that the Medi-Medi program produced limited results and few fraud referrals.

During 2007 and 2008, the 10-state voluntary program received $60 million in appropriations and avoided and recouped $57.8 million. It produced 66 referrals to law enforcement and law enforcement accepted 27 of these referrals. Among the 10 participating states, each State averaged 2.8 Medicare referrals to law enforcement per year and law enforcement accepted an average of 1.15 referrals per state per year.

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