Welcome!

News Feed Item

GAO Investigation Unearths Flaws in CMS Audit Program; Confirms Complaints of Rampant, Out of Control Medicare Audits

WASHINGTON, Sept. 4, 2014 /PRNewswire-USNewswire/ -- A Government Accountability Office (GAO) investigation recently found that the Centers for Medicare & Medicaid Services (CMS) provides insufficient oversight to contractors auditing Medicare reimbursement claims. These inappropriate, multiple audits are crippling the operations of many home medical equipment providers.

The American Association for Homecare (AAHomecare) said the GAO report, which was released earlier this month, underscores the repeated complaints from providers that the rampant out-of- control CMS audit system is placing unfair burdens on their businesses. Read more about this issue and CMS's response to the report in the latest edition of DME Matters: CMS Says It Will Fix Mismanagement Of Medicare Audits

"The GAO report confirms what the industry has been saying for years: the CMS auditing system is poorly managed, is forcing good providers out of business and needs to be significantly revised," said Thomas Ryan, president of AAHomecare. "Hopefully, the GAO report helps create the changes needed to ensure that HME providers can stay in business and supply Medicare beneficiaries with the quality services and products that they deserve."

Ryan noted that Congress is already working on a legislative fix to the audit system.  The recently introduced Audit Improvement and Reform Act (AIR Act), H.R. 5083, will increase transparency, education and outreach, and reward suppliers that have low error rates on audited claims. The AIR Act would apply to all contractors performing audits on durable medical equipment, prosthetics, orthotics, and supplies.

The extent of the audit problem was revealed last December when Administrative Law Judges suspended action on new audit appeals because of the backlog of cases. There are now more than 600,000 cases awaiting appeals. Previous to the suspension, providers repaid the government or didn't get paid during the appeals process. But most appeals were ultimately won by providers and they received the money owed for providing home medical equipment to Medicare patients.

But closing down the appeals process left providers with no recourse and has forced many to shut their businesses or no longer service Medicare patients.

Another factor for providers is the amount of time and resources needed to comply with the army of auditors that CMS has unleashed without proper management.  CMS has hired a variety of contractors that conduct audits of providers - Durable Medical Equipment Medicare Administrative Contractors (DME MACs), Zone Program Integrity Contractors (ZPICs), Recovery Audit Contractors (RACs) and the Comprehensive Error Rate Testing Contractor (CERTs). And what GAO determined is that these entities are not coordinated and are wasting government resources by auditing the same claims, while needlessly burdening the providers.

"This audit process has done a major disservice to providers and to the Medicare beneficiaries who they serve," said Ryan. "The GAO report is a major rebuke of CMS' ability to adequately manage an audit system and provides further evidence that this is bad public policy must be fixed."

Specifically, the GAO report found that:

  • A Recovery Audit Data Warehouse was created to track audits and prevent duplications. But GAO found that the database was not designed to provide information on all possible duplications, and that its data was not reliable because the contracts didn't include the necessary information.
  • Contractors had a low compliance rate on requirements that they communicate to providers their rights during an audit.  This affected the ability of providers to exercise their rights.
  • A lack coordination and oversight by CMS regarding the activities of their audit contractors.
  • CMS has not established clear guidance prohibiting contractors from reviewing the same claims.

The flaws cited in the GAO report got the attention of many on Capitol Hill.

"The provider community has raised numerous concerns about the consistency and accuracy of the audit process over the past few years and this report is the first effort to determine what steps could be taken to improve the process," said Rep. Diana Louise DeGette (D-CO). "The information in this report can now be used by Congress and CMS to help make improvements and ensure more consistent oversight of both the contractors and audit process."

Ryan cautioned that the audit legislation won't solve all the problems, but will help.

Read more about this issue and CMS's response to the report in the latest edition of DME Matters: CMS Says It Will Fix Mismanagement Of Medicare Audits (September 2, 2014)

The American Association for Homecare represents providers of home medical or durable medical equipment and services who serve the needs of millions of Americans who require prescribed oxygen therapy, wheelchairs, enteral feeding, and other medical equipment, services, and supplies at home. Visit www.aahomecare.org.

SOURCE American Association for Homecare

More Stories By PR Newswire

Copyright © 2007 PR Newswire. All rights reserved. Republication or redistribution of PRNewswire content is expressly prohibited without the prior written consent of PRNewswire. PRNewswire shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon.

Latest Stories
SYS-CON Events announced today that Ayehu will exhibit at SYS-CON's 21st International Cloud Expo®, which will take place on October 31 - November 2, 2017 at the Santa Clara Convention Center in Santa Clara California. Ayehu provides IT Process Automation & Orchestration solutions for IT and Security professionals to identify and resolve critical incidents and enable rapid containment, eradication, and recovery from cyber security breaches. Ayehu provides customers greater control over IT infras...
SYS-CON Events announced today that Silicon India has been named “Media Sponsor” of SYS-CON's 21st International Cloud Expo, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Published in Silicon Valley, Silicon India magazine is the premiere platform for CIOs to discuss their innovative enterprise solutions and allows IT vendors to learn about new solutions that can help grow their business.
Artificial intelligence, machine learning, neural networks. We’re in the midst of a wave of excitement around AI such as hasn’t been seen for a few decades. But those previous periods of inflated expectations led to troughs of disappointment. Will this time be different? Most likely. Applications of AI such as predictive analytics are already decreasing costs and improving reliability of industrial machinery. Furthermore, the funding and research going into AI now comes from a wide range of com...
SYS-CON Events announced today that MobiDev, a client-oriented software development company, will exhibit at SYS-CON's 21st International Cloud Expo®, which will take place October 31-November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. MobiDev is a software company that develops and delivers turn-key mobile apps, websites, web services, and complex software systems for startups and enterprises. Since 2009 it has grown from a small group of passionate engineers and business...
SYS-CON Events announced today that Conference Guru has been named “Media Sponsor” of SYS-CON's 21st International Cloud Expo, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. A valuable conference experience generates new contacts, sales leads, potential strategic partners and potential investors; helps gather competitive intelligence and even provides inspiration for new products and services. Conference Guru works with conference organi...
SYS-CON Events announced today that GrapeUp, the leading provider of rapid product development at the speed of business, will exhibit at SYS-CON's 21st International Cloud Expo®, which will take place October 31-November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. Grape Up is a software company, specialized in cloud native application development and professional services related to Cloud Foundry PaaS. With five expert teams that operate in various sectors of the market acr...
In this presentation, Striim CTO and founder Steve Wilkes will discuss practical strategies for counteracting fraud and cyberattacks by leveraging real-time streaming analytics. In his session at @ThingsExpo, Steve Wilkes, Founder and Chief Technology Officer at Striim, will provide a detailed look into leveraging streaming data management to correlate events in real time, and identify potential breaches across IoT and non-IoT systems throughout the enterprise. Strategies for processing massive ...
Internet of @ThingsExpo, taking place October 31 - November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA, is co-located with 21st Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world. The Internet of Things (IoT) is the most profound change in personal and enterprise IT since the creation of the Worldwide Web more than 20 years ago. All major researchers estimate there will be tens of billions devic...
"MobiDev is a Ukraine-based software development company. We do mobile development, and we're specialists in that. But we do full stack software development for entrepreneurs, for emerging companies, and for enterprise ventures," explained Alan Winters, U.S. Head of Business Development at MobiDev, in this SYS-CON.tv interview at 20th Cloud Expo, held June 6-8, 2017, at the Javits Center in New York City, NY.
What's the role of an IT self-service portal when you get to continuous delivery and Infrastructure as Code? This general session showed how to create the continuous delivery culture and eight accelerators for leading the change. Don Demcsak is a DevOps and Cloud Native Modernization Principal for Dell EMC based out of New Jersey. He is a former, long time, Microsoft Most Valuable Professional, specializing in building and architecting Application Delivery Pipelines for hybrid legacy, and cloud ...
With major technology companies and startups seriously embracing Cloud strategies, now is the perfect time to attend 21st Cloud Expo October 31 - November 2, 2017, at the Santa Clara Convention Center, CA, and June 12-14, 2018, at the Javits Center in New York City, NY, and learn what is going on, contribute to the discussions, and ensure that your enterprise is on the right path to Digital Transformation.
21st International Cloud Expo, taking place October 31 - November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA, will feature technical sessions from a rock star conference faculty and the leading industry players in the world. Cloud computing is now being embraced by a majority of enterprises of all sizes. Yesterday's debate about public vs. private has transformed into the reality of hybrid cloud: a recent survey shows that 74% of enterprises have a hybrid cloud strategy. Me...
SYS-CON Events announced today that Cloud Academy named "Bronze Sponsor" of 21st International Cloud Expo which will take place October 31 - November 2, 2017 at the Santa Clara Convention Center in Santa Clara, CA. Cloud Academy is the industry’s most innovative, vendor-neutral cloud technology training platform. Cloud Academy provides continuous learning solutions for individuals and enterprise teams for Amazon Web Services, Microsoft Azure, Google Cloud Platform, and the most popular cloud com...
SYS-CON Events announced today that TechTarget has been named “Media Sponsor” of SYS-CON's 21st International Cloud Expo, which will take place on Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA. TechTarget storage websites are the best online information resource for news, tips and expert advice for the storage, backup and disaster recovery markets.
DevOps at Cloud Expo, taking place October 31 - November 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA, is co-located with 21st Cloud Expo and will feature technical sessions from a rock star conference faculty and the leading industry players in the world. The widespread success of cloud computing is driving the DevOps revolution in enterprise IT. Now as never before, development teams must communicate and collaborate in a dynamic, 24/7/365 environment. There is no time to w...