Congress Asks GAO: Are Medicare Audit Contractors Duplicative?

Beckershospitalreview.com: Written by Bob Herman | June 27, 2012
In a letter (pdf) to the Government Accountability Office, a bipartisan group of Senators and Representatives asked for a study on the effectiveness and coordination among the different Medicare contractors within CMS.

Sens. Orrin Hatch (R-Utah), Max Baucus (D-Mont.) and nine other Congressmen requested a study that zeros in on the five types of Medicare contractors: Medicare Administrative Contractors, Medicare Recovery Auditors, Zone Program Integrity Contractors, Program Safeguard Contractors and Comprehensive Error Rate Testing Review Contractors. All of these contractors are tasked with making sure Medicare pays claims accurately to hospitals, physicians and other providers and catching any fraud and abuse.

Specifically, the group wants the GAO to answer four main questions:

1. What process does CMS use to determine whether the contractors’ audit criteria and methodologies are valid, clear and consistent?

2. How does CMS coordinate among these contractors to ensure their interactions with providers are not duplicative? Read more