At the end of last month, we blogged about numerous government agencies, departments, and others, including Medicaid Integrity Contractors, charged with uncovering Medicaid fraud and overpayments.  Now, comes word that one such department, the Medicaid Integrity Group (“MIG”), established by the Centers for Medicare & Medicaid Services (“CMS”) to ensure Medicaid funds are spent with minimal waste, is itself guilty of redundancy and waste as per the U.S. Government Accountability Office (“GAO”).

Earlier this week, the GAO released a report detailing the results of an investigation into MIG’s National Medicaid Audit Program (“Audit Program”).  This Audit Program is responsible for uncovering waste and fraud in state Medicaid programs, and is responsible for more than 50% of MIG’s budget.  Some of the highlights of this report are as follows:

  • The hiring by MIG of “separate review and audit contractors for its…Audit Program…was inefficient and led to duplication because key functions were performed by both entities.”  While acknowledging that review and audit contractors have different objectives, the GAO found that their investigations often overlap, thereby doubling the burden upon states—the ones responsible for administering Medicaid programs.  In order to eliminate this redundancy, the GAO recommended merging the functions of review and audit contractors.
  • When state Medicaid programs were audited by audit contractors, such audits took an average of nearly two (2) years to complete; but when audit contractors coordinated their efforts with review contractors, such audits were able to be performed within 16 months, and more overpayments were discovered.  In order to better target audits and reduce their duration, the GAO recommended that comprehensive reviews be used.    
  • In spite of free training provided to state officials through the Medicaid Integrity Institute, the evaluation of state program integrity procedures through comprehensive reviews every three (3) years, and the collection of data from states through annual assessments, there was no evidence of consistent benefits with respect to program integrity.  Accordingly, the GAO recommended that MIG follow-up with states to ensure reliable reporting of their program integrity recoveries.
  • The data collected from the states through annual program integrity assessments is the same data collected from other reporting activities, and these other reports are more accurate and up-to-date.  Accordingly, the GAO recommended that such state program integrity assessments be discontinued.
  • The Audit Program publishes annually figures showing the amount it recovers as a result of its audits; but the GAO found that it is unclear how CMS calculates such figures and the resulting return on investment.  Accordingly, the GAO recommended that the Audit Program’s return on investment methodology be reevaluated.

Therefore, while many government agencies, contractors, and others are charged with uncovering Medicaid fraud and waste, and are actively engaged in attempting to do so, this week’s GAO report shows that this does not necessarily correlate to increased efficiencies and better results.