Government finds Medicaid, Medicare recovery audit contractors inefficient

Recovery auditors for Medicaid have been found to be less efficient at uncovering fraud and overpayments than auditors at Medicare, said the House Subcommittee on Government Organization, Efficiency and Financial Management in a recent hearing.

According to McKnight's Long-Term Care News, the Centers for Medicare & Medicaid Services (CMS) told the committee this is due to the different laws in each state pertaining to Medicaid. The news source also reports that CMS admitted mistakes made by recovery audit contractors, which has long been a concern of the Department of Health and Human Services Office of the Inspector General (OIG). The OIG states it has issues with whether or not contractors follow fraud identity standards and how often payments are reported to authorities and recovered.

Fierce Healthcare states that the OIG and the Government Accountability Office (GAO) believe the Medicaid and Medicare programs are easily exposed to fraud because of a lack of oversight and a system of checks and balances. Last year, Medicaid had $21.9 billion in overpayments, while Medicare had approximately $43 billion, according to CMS.

"It is critical that CMS and the states continue working on reducing improper payments," said the GAO in its report. "While both have made efforts to reduce improper payments, further action is needed."

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