White Paper Informs Senate of Major Flaws in CMS Audits

VGM, providers, law firm submit document that informs Finance Committee of key problems with audit structure and their solutions.

• By David Kopf
• Jul 18, 2012

In response to a request from the Senate Committee on Finance, the VGM Group and several independent providers have released a white paper outlining problems with, and offering solutions to, the Medicare auditing system.

On May 2, the U.S. Senate Committee on Finance solicited the healthcare industry and related stakeholders for their recommendations on ways to curb fraud, waste and abuse in the Medicare system. This marked the first time the Committee asked for or allowed industry stakeholders to offer suggestions directly to national policymakers.

The whitepaper, “Medicare Payment Integrity Reforms to Ensure Accuracy, Efficiency and Value,” which was prepared by  Edward Vishnevetsky, Esq. of law firm Munsch Hardt Kopf & Harr, P.C, contends that the current auditing system suffers from four main problems: (1) lack of oversight; (2) lack of regulations and standardization; (3) lack of transparency; and (4) lack of accountability and enforcement.  

Bearing that in mind, the 31-page white paper combines legal argument with anecdotal evidence to advocate for 15 specific changes to the auditing system that would solve those four key problems.  Among the 15 solutions:

1. Requiring auditors to abide by Medicare’s regulatory guidelines;
2. Creating benchmarks to establish the beginning and end of prepayment audit;
3. Requiring auditors to pay interest on improperly-denied claims;
4. Establishing objective criteria within NCDs/LCDs;
5. Incorporating less severe sanctions against audited providers; and
6. Not holding DMEPOS suppliers responsible for provider documentation over which they have no control;

The Senate Finance Committee has indicated it will review the various white paper submissions and prepare a report later this year.

“VGM would like to thank attorneys Edward Vishnevetsky, Peter Chen and Chris Demeo of Munsch Hardt Kopf & Harr, P.C. for preparing the white paper.  Mr. Vishnevetsky has successfully represented numerous health care providers, including DMEPOS suppliers, in audit and other health care matters,” said Mark Higley, VGM's vice president of development.