The Government Accountability Office has issued a report recommending CMS more clearly communicate its goals for the Medicare Integrity Program and improve the reliability of data used to calculate the MIP's return on investment.
MIP is designed to identify and address fraud, waste and abuse within the Medicare program that result in improper payments. The program has seen an increase in funding, growing from $832 million in fiscal year 2006 to $1 billion in 2010, to expand its activities. The GAO was asked to report on how effectively CMS was using this funding and how CMS measures the program's effectiveness.
In the report, the GAO states that CMS is using flawed data to determine MIP's return on investment. First, the ROI calculations are not updated when program expenditure data is updated. Second, "CMS does not have reliable information to determine the amount of MIP spending by activity for one type of contractor that received about 22 percent of total MIP funding" in 2010, according to the report.
In addition, "In interviews with GAO, CMS officials with direct responsibility for implementing MIP activities generally did not connect the measurement of effectiveness of MIP activities with these CMS goals to reduce improper payments and instead cited other measures of effectiveness," according to the report.
The GAO says the latter finding suggests that CMS has not "clearly communicated" the relationship between daily MIP work and larger improper payment reduction goals.
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MIP is designed to identify and address fraud, waste and abuse within the Medicare program that result in improper payments. The program has seen an increase in funding, growing from $832 million in fiscal year 2006 to $1 billion in 2010, to expand its activities. The GAO was asked to report on how effectively CMS was using this funding and how CMS measures the program's effectiveness.
In the report, the GAO states that CMS is using flawed data to determine MIP's return on investment. First, the ROI calculations are not updated when program expenditure data is updated. Second, "CMS does not have reliable information to determine the amount of MIP spending by activity for one type of contractor that received about 22 percent of total MIP funding" in 2010, according to the report.
In addition, "In interviews with GAO, CMS officials with direct responsibility for implementing MIP activities generally did not connect the measurement of effectiveness of MIP activities with these CMS goals to reduce improper payments and instead cited other measures of effectiveness," according to the report.
The GAO says the latter finding suggests that CMS has not "clearly communicated" the relationship between daily MIP work and larger improper payment reduction goals.
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