GAO Recommends Increased Oversight and Guidance to Improve Postpayment Claims Reviews

August 20, 2014 | Strategic Insights for Health System


The Centers for Medicare and Medicaid Services (CMS) does not have reliable enough data or provide sufficient oversight and guidance to properly prevent its contractors from conducting duplicative postpayment claims reviews, asserts the U.S. Government Accountability Office (GAO) in an August 13, 2014, report. According to the report, CMS previously implemented a database to track the activities of recovery auditors, who conduct most of the postpayment reviews, and prevent them from duplicating other contractors' reviews. However, this database was not designed to provide information on all possible duplication, and the data is not reliable because other postpayment contractors, such as Medicare administrative contractors, zone program integrity coordinators, and comprehensive error rate testing contractors, do not consistently enter information about their reviews.

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