OIG Uncovers Flaws in CMS Processes, Programs
Few fraud referrals
In comparison, each state averaged 0.5 Medicaid referrals to law enforcement per year; law enforcement accepted an average of 0.2 referrals per state per year, according to the report. As a result of these findings, the OIG recommended that CMS reevaluate the goals, structure and operations of the Medi-Medi program to determine what aspect of the program, if any, should be part of CMS’ overall program integrity strategy.
CMS agreed with the OIG’s assessment, stating that since the period of the review, it has made significant strides in enhancing the effectiveness of the Medi-Medi program, but the OIG states that CMS has yet to provide any data to illustrate the enhanced effectiveness of the program.
Providing this data would enable Congress to make an informed decision whether to continue to fund the program and enable State and Federal agencies to make an informed decision on whether to participate.
James Carroll is associate editor for the HCPro Revenue Cycle Institute.
- Doc Shortage 'Fix' Is a Disaster Waiting to Happen
- Physician Pay Increasingly Linked to Value-based Metrics
- MU Slides into Summer of Discontent
- 2015 OPPS Proposed Rule Detailed
- ACGME Chief Sees 'Huge' Risk of Error in Proposed Assistant Physician Licensure
- CDC Expanding Quality of Care Efforts
- Critical Times for Small and Rural Hospitals
- 4 Hot Healthcare Exec Titles; 1 Not
- Advanced EHRs Save 10% Per Patient, Study Says
- Fees Lurk in Health Plans' Shift to e-Payments