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.
Open Recommendations
Recommendation Number | Significant Recommendation | Recommended Questioned Costs | Recommended Funds for Better Use | Additional Details | |
---|---|---|---|---|---|
270063 | No | $0 | $0 | ||
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 | No | $0 | $0 | ||
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. |