CMS to Audit its Audits

Criticism at fraud summit pushes agency to review complaints over its sharply increased claims audits.

CMS anti-fraud czar Peter Budetti came under criticism from HME industry and hospital representatives about its over-reaching audit programs at last week’s federal fraud-prevention summit, held in Philadelphia.

During the invitation-only summit, which was attended by 300 healthcare providers and law enforcement personnel, John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, asked Budetti, “Who’s guarding the guardians?” and likened CMS’s current audit frenzy to TSA airport screenings where “85-year-old grandmothers and toddlers are getting patted down.”

In response, Budetti, deputy administrator for the Center for Program Integrity at CMS, said the agency will conduct an “audit audit” to investigate the merit of those complaints. CMS Administrator Donald Berwick, who participated in the discussions, admitted that audits are “a blunt tool.”

At the end of the day-long summit, Shantanu Agrawal, MD, the new medical director for the Center for Program Integrity, commented, “We heard a lot of concerns about the number and frequency of audits, so we take that to heart.”

Earlier this month, representatives from the American Association for Homecare met with CMS to express concerns over the audits, and presented recommendations for what documentation should be requested in audits for CPAP, oxygen, enteral nutrition, diabetic supplies, power mobility devices, and nebulizers. The recommendations were based on what the association said it believes is appropriate, given the corresponding coverage policies and Medicare instructions.  

About the Author

David Kopf is the Publisher and Executive Editor of HME Business and DME Pharmacy magazines. Follow him on LinkedIn at and on Twitter at @postacutenews.

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