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GAO Recommends Changing Medicaid Audit Program Due To Poor Results

Posted in Department of Health and Human Services, Fraud and Abuse

It appears that the National Medicaid Audit Program hasn’t been worth the money it cost to run.  According to published testimony released by the Government Accountability Office (GAO) today, only 4% of the 1,550 audits, though, resulted in refunds to the government of approximately $7.4 million.  More than two-thirds of the audits found no overpayments.  The remaining 27% of the audits are ongoing.  However, Bloomberg BusinessWeek reports that the program designed to detect fraud and abuse by Medicaid providers has cost $102 million. 

According to an interview reported in the Bloomberg BusinessWeek, Peter Budetti (director of program integrity CMS) says that, of the 10 auditing companies currently doing the work, two will be reassigned and three will be terminated as a result of these findings.

The GAO recommends, and HHS concurs, that future Medicaid audits be conducted as collaborative audits, where state officials will assist in targeting providers to be audited, or using state data.  The GAO reports that such audits have been more productive due to more fulsome data collected by the states. So far, less than 35 audits using state data have already recovered more than $12 million in overpayments.