The Medicaid Integrity Group’s hiring of separate review and audit contractors for its National Medicaid Audit Program was inefficient and led to duplication because key functions were performed by both entities, GAO has found.
Improper payments through Medicaid cost the Treasury billions. GAO said review contractors analyze state claims data to identify aberrant claims or billing anomalies while audit contractors conduct post-payment audits, but having separate contractors has doubled the burden placed on states.
Further, poor coordination and communication between the two types of contractors resulted in duplicative data analysis, according to GAO-13-50.
It said those inefficiencies added to the length of audits, which on average took almost 23 months to complete. A more collaborative and coordinated approach was 16 months, and the amount of identified overpayments increased significantly.
Other activities such as free training provided to state officials through the Medicaid Integrity Institute show mixed results in enhancing program integrity efforts, and the data collected through state program integrity assessments are not validated and not as current as other data, GAO said.
The Department of Health and Human Services agreed to direct the CMS administrator to eliminate duplication by merging contractor functions, use comprehensive reviews to better target audits, and follow up with states to ensure reliable reporting of their program integrity recoveries.
It partially agreed with recommendations to discontinue the state assessments, as well as to reevaluate CMS’s return on investment methodology.