The U.S. Government Accountability Office (GAO) recently issued a report entitled “Medicare Program Integrity: Increased Oversight and Guidance Could Improve Effectiveness and Efficiency of Post-Payment Claims Reviews,” which analyzes the processes used by the Centers for Medicare & Medicaid Services (CMS) to avoid the duplication of post-payment claims reviews by its contractors. GAO’s report focused on the extent to which:
- CMS has data to assess whether the CMS contractors conduct duplicative post-payment claims reviews and whether CMS ensures that these contractors do so only when appropriate;
- CMS’ requirements for contractor correspondence with providers help ensure effective communication;
- CMS uses quality assurance processes to ensure that contractors’ post-payment claims review decisions about whether claims were paid properly are appropriate; and
- CMS has strategies for coordination of post-payment claims review activities among different types of contractors.