Congress Questions CMS on Audits

House subcommittee chair blasts CMS for ‘incompetence’ in audit oversight.

The House Energy and Commerce Oversight Subcommittee questioned officials from the Centers for Medicare and Medicaid Services in detail concerning CMS’s oversight of its audit contractors at a hearing late last week.

Subcommittee chairman, Rep. Cliff Stearns (R-Fla.) and other committee members expressed concern about CMS's management of its contractors, and noted that CMS sent the committee incorrect information on ZPIC performance data, according to the American Association for Homecare, which had representatives attending the meeting.

Referring to incorrect data CMS supplied to Congress Stearns commented in his opening statement that the error “confirms CMS’s utter incompetence in conducting any meaningful oversight of these contractors — a point that is echoed loud and clear in the [Inspector General's] prepared testimony.”

The burden audits were placing on providers, and especially HMEs, was a key concern to lawmakers on the subcommittee, according to AAHomecare. Rep. Marsha Blackburn (R-Tenn.) expressed concern about the "high administrative burden and the cost of auditing" on HME providers. Blackburn stated that HME claims average about $75 per month, yet ZPIC and other auditors are very aggressively pursuing HME providers. She pointed out that HME providers are receiving multiple audit letters on a per-patient basis. Private insurers, she said, send out audits more efficiently, either by sending a spreadsheet or an email with all of the claims being audited.

There is no real due process, no timeframe for resolution of ZPIC audits, and no opportunity for dialog under the audits, according to Rep. Kathy Castor (D-Fla.) reported she had had heard from a number of stakeholders about ZPIC auditors. Castor will be submitting questions regarding ZPICS for CMS to answer as part of the hearing record.

The hearing also gave indications of additional review of CMS’s audits that are currently in the works:

  • The GAO has launched a report on oversight of ZPICs soon.
  • CMS will provide a report to Congress on the first year of implementation of the predictive modeling system by Sept. 30.
  • The GAO is also working on a report on predictive modeling that will compare CMS' use of the technologies with similar private sector efforts.

About the Author

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

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