The Office of Inspector General has released a report suggesting CMS has not been using error rate data to identify and focus on error-prone providers, according to an OIG report.
The four categories of errors reported by CMS are incorrect coding, medically unnecessary services, documentation errors and other errors. The OIG said these errors make up most of the $44.1 billion in improper payments to healthcare providers. The OIG also found in fiscal year 2005-2008 there were 740 error-prone providers. The agency suggests that CMS focus on error-prone healthcare providers in order to significantly reduce the amount of improper payments. The OIG's four recommendations include the following:
• Use available error rate data to identify error-prone providers.
• Require error-prone providers to identify the root causes of claim errors and to develop and implement corrective action plans.
• Monitor provider-specific corrective actions plans.
• Share error rate data with its contractors to assist in identifying improper payments.
Read the OIG's report on CMS' use of error rate data (pdf).
Read other coverage about healthcare fraud reports:
- WSJ: AMA Keeping Data on Physicians and Individual Healthcare Providers Confidential
- Report: Number of Suspected New York Medicaid Fraud Cases Doubled Since Last Year
The four categories of errors reported by CMS are incorrect coding, medically unnecessary services, documentation errors and other errors. The OIG said these errors make up most of the $44.1 billion in improper payments to healthcare providers. The OIG also found in fiscal year 2005-2008 there were 740 error-prone providers. The agency suggests that CMS focus on error-prone healthcare providers in order to significantly reduce the amount of improper payments. The OIG's four recommendations include the following:
• Use available error rate data to identify error-prone providers.
• Require error-prone providers to identify the root causes of claim errors and to develop and implement corrective action plans.
• Monitor provider-specific corrective actions plans.
• Share error rate data with its contractors to assist in identifying improper payments.
Read the OIG's report on CMS' use of error rate data (pdf).
Read other coverage about healthcare fraud reports:
- WSJ: AMA Keeping Data on Physicians and Individual Healthcare Providers Confidential
- Report: Number of Suspected New York Medicaid Fraud Cases Doubled Since Last Year