Report: Medicaid Audit Program Flawed

Audits Coming Up Short in Finding Overpayments
Report: Medicaid Audit Program Flawed

The Medicaid Integrity Contractor Audit Program is doing an inadequate job of identifying overpayments related to fraud and other reasons, according to a new report.

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The report from the Department of Health and Human Services' Office of the Inspector General says efforts to find overpayments were hindered, in part, because audit targets were poorly selected. It also cites problems with the data used for the audits as well as the analyses conducted.

The report recommends the use of more "collaborative audits" involving audit contractors, contractors that review audits, the states and the Centers for Medicare and Medicaid Services.

The OIG report analyzed audit results for the first six months of 2010, when 370 audits were launched with $80 million in potential overpayments. Only 11 percent of audits were completed, with findings of $6.9 million in overpayments. The report found that 81 percent of the audits either did not identify overpayments or are unlikely to identify them.

About the Author

Howard Anderson

Howard Anderson

News Editor, ISMG

Anderson is news editor of Information Security Media Group and was founding editor of HealthcareInfoSecurity and DataBreachToday. He has more than 40 years of journalism experience, with a focus on healthcare information technology issues. Before launching HealthcareInfoSecurity, he served as founding editor of Health Data Management magazine, where he worked for 17 years, and he served in leadership roles at several other healthcare magazines and newspapers.

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