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CMS And Its Contractors Did Not Use Comprehensive Error Rate Testing Program Data To Identify And Focus On Error-Prone Providers

Submitting OIG: 
Department of Health & Human Services OIG
Report Description: 
Public law requires the heads of Federal agencies to annually review programs that they administer to identify and develop actions to reduce improper payments.The Centers for Medicare & Medicaid Services (CMS) administers the Comprehensive Error Rate Testing (CERT) program to measure improper Medicare fee-for-service payments to providers.Previous OIG reports recommended using CERT data to identify and focus on providers that were prone to having errors.Our objective was to determine whether CMS and its contractors used CERT program data to identify and focus on error-prone providers.
Date Issued: 
Friday, January 15, 2021
Agency Reviewed / Investigated: 
Department of Health & Human Services
Submitting OIG-Specific Report Number: 
A-05-17-00023
Component, if applicable: 
Centers for Medicare & Medicaid Services
Location(s): 
Agency-Wide
Type of Report: 
Audit
Questioned Costs: 
$0
Funds for Better Use: 
$0
Number of Recommendations: 
2
View Document: 
AttachmentSize
Binary Data xAvgN2.27 MB

Related Open Recommendations

Recommendation Number Recommendation Status Significant Recommendation Additional Details
270063 Open No
We recommend that the Centers for Medicare & Medicaid Services review the list of 100 error-prone providers identified in this audit and take specific action as appropriate, such as prior authorization, prepayment reviews, and postpayment review.
270064 Open No
We recommend that the Centers for Medicare & Medicaid Services use annual CERT data to identify individual providers that have an increased risk of receiving improper payments and apply additional program integrity tools to these providers.
Displaying 2 of 2 Recommendations