Sneak Preview: CMS Seeks To Remove Collaborative Audit Barriers

May 12, 2017 | By Jerry Ashworth | Post a Comment

xsass_bookshot(The following was excerpted from a recent article in the Single Audit Information Service.) The Department of Health and Human Services’ (HHS) Centers for Medicare and Medicaid Services (CMS) aims to provide more resources to contractors it hires to perform program integrity audits, called “collaborative audits,” of state Medicaid providers, in response to a recent recommendation by the Government Accountability Office (GAO). HHS officials said doing so would enable the contracted auditor to better communicate with state officials and encourage more participation in collaborative audits, which have identified millions in Medicaid overpayments.

The federal government categorizes Medicaid as a high-risk program, partly due to concerns about improper payments. CMS has a range of program integrity activities that it uses to oversee and support state Medicaid programs, including conducting on-site reviews of state program integrity efforts, conducting collaborative audits and providing training to states on improving Medicaid program integrity.

Each year, CMS selects a group of states and reviews aspects of their program integrity efforts. From federal fiscal year (FY) 2007 to FY 2013, CMS conducted comprehensive on-site regulation-based reviews of each state’s program integrity activities. In FY 2014, CMS shifted the focus of the reviews from a comprehensive review approach to a “focused review” approach. CMS said this approach aims to focus on high-risk areas of concern particular to each state, reduce the burden on states and identify more opportunities to provide technical assistance to the states. States are required to submit corrective action plans for addressing any areas of regulatory noncompliance that CMS identifies, and CMS will follow up on those corrective actions. From FY 2014 to FY 2016, CMS conducted on-sites reviews in 31 states.

In addition, CMS uses its state program integrity review to collect and report promising program integrity practices. However, GAO found that these practices are not collected in a consistent manner, and the published reports are not timely nor easily searched electronically. Further, GAO noted that the number of state reviews that included promising practices declined from 80 percent in FY 2013 to 25 percent in FY 2015.

“CMS lacks a systematic approach to collecting promising state program integrity practices and communicating them to other states,” GAO said. “As such, CMS may not be aware of the full range of promising practices that exist in states’ varied environments. Federal internal control standards stipulate that management should use quality information and externally communicate the necessary quality information to achieve the entity’s objectives.”

(The full version of this story has now been made available to all for a limited time on Thompson’s Grants Compliance Expert site.)

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