GAO: CMS should tighten up integrity program goals
A recent report from the Government Accountability Office (GAO) cited that while the Centers for Medicare & Medicaid Services (CMS) considers a variety of factors when allocating its Medicare Integrity Program (MIP), the organization may consider the prior year’s funding level, the consequence of not funding and the performance goal that the activity is intended to meet based on GAO’s review of CMS documents submitted to justify funding of specific MIP activities.
The Medicare program makes about $500 billion in payments per year and continues to have a significant amount of improper payments—almost $48 billion in fiscal year 2010. CMS’ MIP is designed to identify and address fraud, waste and abuse; all of which are considered causes of improper payments.
GAO was asked to report on how effectively CMS is using MIP funding to address Medicare program integrity. GAO examined how CMS used MIP funding to support the program’s activities from fiscal years 2006 through 2010, how CMS assesses the effectiveness of MIP and factors CMS considers when allocating MIP funding.
According to GAO’s analysis of CMS’ budget and other documents, interviews with CMS officials and reviews of the agency’s method of calculating return on investment, CMS used the increase in total MIP funding received, from $832 million in fiscal year 2006 to $1 billion in fiscal year 2010 to expand MIP’s activities.
“CMS officials also reported that CMS was able to move some funding from activities, such as provider audit, to other activities because of savings achieved from consolidating contractors,” the report stated. “The largest percentage increase from this redistribution went to benefit integrity activities, which aim to deter and detect Medicare fraud through proactive data analysis and coordination with law enforcement.”
In interviews with GAO, CMS officials with direct responsibility for implementing MIP activities generally did not connect the measurement of effectiveness of MIP activities with CMS goals of reducing improper payments and instead cited other measures of effectiveness, according to the report. “This suggested that CMS has not clearly communicated to its staff the relationship between the daily work of conducting MIP activities and the agency’s improper payment reduction performance goals,” the report stated.
“Because MIP will be central to CMS’ efforts to reduce Medicare improper payments, MIP staff need to understand how their work supports these goals,” the report concluded. “GAO recommends that CMS communicate the linkage … and that CMS expeditiously improve the reliability of data used to calculate return on investment.”
The Medicare program makes about $500 billion in payments per year and continues to have a significant amount of improper payments—almost $48 billion in fiscal year 2010. CMS’ MIP is designed to identify and address fraud, waste and abuse; all of which are considered causes of improper payments.
GAO was asked to report on how effectively CMS is using MIP funding to address Medicare program integrity. GAO examined how CMS used MIP funding to support the program’s activities from fiscal years 2006 through 2010, how CMS assesses the effectiveness of MIP and factors CMS considers when allocating MIP funding.
According to GAO’s analysis of CMS’ budget and other documents, interviews with CMS officials and reviews of the agency’s method of calculating return on investment, CMS used the increase in total MIP funding received, from $832 million in fiscal year 2006 to $1 billion in fiscal year 2010 to expand MIP’s activities.
“CMS officials also reported that CMS was able to move some funding from activities, such as provider audit, to other activities because of savings achieved from consolidating contractors,” the report stated. “The largest percentage increase from this redistribution went to benefit integrity activities, which aim to deter and detect Medicare fraud through proactive data analysis and coordination with law enforcement.”
In interviews with GAO, CMS officials with direct responsibility for implementing MIP activities generally did not connect the measurement of effectiveness of MIP activities with CMS goals of reducing improper payments and instead cited other measures of effectiveness, according to the report. “This suggested that CMS has not clearly communicated to its staff the relationship between the daily work of conducting MIP activities and the agency’s improper payment reduction performance goals,” the report stated.
“Because MIP will be central to CMS’ efforts to reduce Medicare improper payments, MIP staff need to understand how their work supports these goals,” the report concluded. “GAO recommends that CMS communicate the linkage … and that CMS expeditiously improve the reliability of data used to calculate return on investment.”