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Report File
Date Issued
Submitting OIG
Department of Health & Human Services OIG
Other Participating OIGs
Department of Health & Human Services OIG
Agencies Reviewed/Investigated
Department of Health & Human Services
Components
Centers for Medicare and Medicaid Services
Report Number
OEI-09-18-00260
Report Type
Inspection / Evaluation
Number of Recommendations
3
Questioned Costs
$0
Funds for Better Use
$0

Open Recommendations

This report has 3 open recommendations.
Recommendation Number Significant Recommendation Recommended Questioned Costs Recommended Funds for Better Use Additional Details
22-E-09-015.01 No $0 $0

CMS should Issue new guidance on the appropriate use of MAO clinical criteria in medical necessity reviews.

22-E-09-015.02 No $0 $0

CMS should Update its audit protocols to address the issues identified in this report, such as MAO use of clinical criteria, and/or examine particular service types.

22-E-09-015.03 No $0 $0

CMS should direct MAOs to take additional steps to identify and address vulnerabilities that can lead to manual review errors and system errors.

Department of Health & Human Services OIG

United States