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Government Accountability Office Report–Limited Oversight of Efforts Aimed at Reducing Improper Billing

Apr 11, 2017

A report released today by the Government Accountability Office (GAO) found that the Centers for Medicare and Medicaid (CMS)’s oversight and requirements of Medicare Administrative Contractors (MACs) efforts to reduce improper billing are limited. These findings are important because the Department of Health and Human Services (HHS) recently reported an estimated 11 percent improper payment rate and $41.1B in improper payments in the Medicare fee-for-service program. MACs play an important role in educating providers on Medicare billing requirements and could greatly assist in CMS’ efforts aimed at reducing improper payments. 

GAO recommends that CMS should:

  1. Require sufficient detail in MAC reporting to determine the extent to which MACs’ provider education department efforts focus on vulnerable areas
  2. Explicitly require MACs to work together to educate referring providers on proper documentation for durable medical equipment (DME) and home health services
  3. Establish performance metrics for future probe and educate reviews

The agency concurred with GAO’s recommendations. View the full report here.