U.S. Senate Committee on Aging Reports on Improving Medicare Audits.

Date posted: August 6, 2014

The U.S. Senate Committee on Aging recently issued a report, which examined plans by the Department of Health and Human Services for reducing the 2013 improper payment rate. Specifically, the report reviewed: (1) the variety of edit, audit, and review mechanisms available to the Center for Medicare & Medicaid (CMS); (2) complaints by Stakeholders relating to CMS’ audit and review activities; and (3) areas of potential overlap.

Key highlights of the committee’s findings include:

  • CMS audits may be duplicative and do not always provide an educational purpose;
  • CMS must oversee error rate reduction plans more effectively; and
  • Recovery Audit Contractor incentive structure is based on recovering past improper payments, and not reducing future improper payments.

The committee staff made several recommendations for CMS, such as:

  • Stress provider education as a means of reducing improper payments;
  • Consolidate post-payment reviewactivities; and
  • Consider financial incentives based on the reduction of improper payment rates, rather than solely on the amount of improper payments identified.

The U.S. Senate Special Committee on Aging Staff Report is available at:

http://www.aging.senate.gov/imo/media/doc/Improving%20Audits%20-%20Improper%20Payments%20Report%20-%20FINAL.pdf.

United States Senate Special Committee on Aging.  “Improving Audits: How We Can Strengthen the Medicare Program for Future Generations.”  9 Jul. 2014.

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