GAO pokes holes in CMS’s MA audit program

Tuesday, May 10, 2016

WASHINGTON – The Government Accountability Office isn’t pleased with CMS’s progress in recovering substantial amounts of improper payments from Medicare Advantage organizations. The agency currently uses risk adjustment data validation audits to recover improper payments in the MA program. The GAO found that CMS’s methodology does not result in the selection of contracts for audit that have the greatest potential for recovery of improper payments. The GAO also found “substantial delays” in the audits. It says RADV audits of 2007 and 2011 payments have taken multiple years and are still ongoing for several reasons. Additionally, it noted that CMS did not expand the recovery audit program to MA by the end of 2010, as required by the Patient Protection and Affordable Care Act. In 2014, Medicare paid about $160 billion to MA organizations to provide healthcare services to 16 million beneficiaries. CMS estimates that about 9.5% of those payments were improper.