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
Agile has finally jumped the technology shark, expanding outside the software world. Enterprises are now increasingly adopting Agile practices across their organizations in order to successfully navigate the disruptive waters that threaten to drown them. In our quest for establishing change as a core competency in our organizations, this business-centric notion of Agile is an essential component of Agile Digital Transformation. In the years since the publication of the Agile Manifesto, the conn...
"We're developing a software that is based on the cloud environment and we are providing those services to corporations and the general public," explained Seungmin Kim, CEO/CTO of SM Systems Inc., in this SYS-CON.tv interview at 21st Cloud Expo, held Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA.
SYS-CON Events announced today that CrowdReviews.com has been named “Media Sponsor” of SYS-CON's 22nd International Cloud Expo, which will take place on June 5–7, 2018, at the Javits Center in New York City, NY. CrowdReviews.com is a transparent online platform for determining which products and services are the best based on the opinion of the crowd. The crowd consists of Internet users that have experienced products and services first-hand and have an interest in letting other potential buye...
The question before companies today is not whether to become intelligent, it’s a question of how and how fast. The key is to adopt and deploy an intelligent application strategy while simultaneously preparing to scale that intelligence. In her session at 21st Cloud Expo, Sangeeta Chakraborty, Chief Customer Officer at Ayasdi, provided a tactical framework to become a truly intelligent enterprise, including how to identify the right applications for AI, how to build a Center of Excellence to oper...
"IBM is really all in on blockchain. We take a look at sort of the history of blockchain ledger technologies. It started out with bitcoin, Ethereum, and IBM evaluated these particular blockchain technologies and found they were anonymous and permissionless and that many companies were looking for permissioned blockchain," stated René Bostic, Technical VP of the IBM Cloud Unit in North America, in this SYS-CON.tv interview at 21st Cloud Expo, held Oct 31 – Nov 2, 2017, at the Santa Clara Conventi...
SYS-CON Events announced today that Telecom Reseller has been named “Media Sponsor” of SYS-CON's 22nd International Cloud Expo, which will take place on June 5-7, 2018, at the Javits Center in New York, NY. Telecom Reseller reports on Unified Communications, UCaaS, BPaaS for enterprise and SMBs. They report extensively on both customer premises based solutions such as IP-PBX as well as cloud based and hosted platforms.
In his session at 21st Cloud Expo, James Henry, Co-CEO/CTO of Calgary Scientific Inc., introduced you to the challenges, solutions and benefits of training AI systems to solve visual problems with an emphasis on improving AIs with continuous training in the field. He explored applications in several industries and discussed technologies that allow the deployment of advanced visualization solutions to the cloud.
While some developers care passionately about how data centers and clouds are architected, for most, it is only the end result that matters. To the majority of companies, technology exists to solve a business problem, and only delivers value when it is solving that problem. 2017 brings the mainstream adoption of containers for production workloads. In his session at 21st Cloud Expo, Ben McCormack, VP of Operations at Evernote, discussed how data centers of the future will be managed, how the p...
Large industrial manufacturing organizations are adopting the agile principles of cloud software companies. The industrial manufacturing development process has not scaled over time. Now that design CAD teams are geographically distributed, centralizing their work is key. With large multi-gigabyte projects, outdated tools have stifled industrial team agility, time-to-market milestones, and impacted P&L stakeholders.
Enterprises are adopting Kubernetes to accelerate the development and the delivery of cloud-native applications. However, sharing a Kubernetes cluster between members of the same team can be challenging. And, sharing clusters across multiple teams is even harder. Kubernetes offers several constructs to help implement segmentation and isolation. However, these primitives can be complex to understand and apply. As a result, it’s becoming common for enterprises to end up with several clusters. Thi...
"NetApp is known as a data management leader but we do a lot more than just data management on-prem with the data centers of our customers. We're also big in the hybrid cloud," explained Wes Talbert, Principal Architect at NetApp, in this SYS-CON.tv interview at 21st Cloud Expo, held Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA.
"We're focused on how to get some of the attributes that you would expect from an Amazon, Azure, Google, and doing that on-prem. We believe today that you can actually get those types of things done with certain architectures available in the market today," explained Steve Conner, VP of Sales at Cloudistics, in this SYS-CON.tv interview at 21st Cloud Expo, held Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA.
"Space Monkey by Vivent Smart Home is a product that is a distributed cloud-based edge storage network. Vivent Smart Home, our parent company, is a smart home provider that places a lot of hard drives across homes in North America," explained JT Olds, Director of Engineering, and Brandon Crowfeather, Product Manager, at Vivint Smart Home, in this SYS-CON.tv interview at @ThingsExpo, held Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clara, CA.
Coca-Cola’s Google powered digital signage system lays the groundwork for a more valuable connection between Coke and its customers. Digital signs pair software with high-resolution displays so that a message can be changed instantly based on what the operator wants to communicate or sell. In their Day 3 Keynote at 21st Cloud Expo, Greg Chambers, Global Group Director, Digital Innovation, Coca-Cola, and Vidya Nagarajan, a Senior Product Manager at Google, discussed how from store operations and ...
"Cloud Academy is an enterprise training platform for the cloud, specifically public clouds. We offer guided learning experiences on AWS, Azure, Google Cloud and all the surrounding methodologies and technologies that you need to know and your teams need to know in order to leverage the full benefits of the cloud," explained Alex Brower, VP of Marketing at Cloud Academy, in this SYS-CON.tv interview at 21st Cloud Expo, held Oct 31 – Nov 2, 2017, at the Santa Clara Convention Center in Santa Clar...