Providers lament 'strange approach' to audits

Sunday, September 30, 2007

HARRISBURG, Pa. - A recent Medicaid audit has the provider community here questioning the state's auditing methods and its claims of error rates as high 90%.
The audit of about 50 oxygen providers was conducted in 2005, but the state didn't publish results until July.
"Patients were horrified; they thought the companies were under investigation," said John Shirvinksy, executive director of the Pennsylvania Association of Medical Equipment Suppliers (PAMS). "The (auditors) were ex-law enforcement types. They know nothing about Medicaid. It's a strange approach."
Shirvinsky questioned the findings and penalties of the audit, which was conducted by the Department of Public Welfare's Bureau of Program Integrity.
"These were relatively minor paperwork errors that could result in the taking back of the entire amount of money paid," said Shirvinsky.
Part of the problem may be that many of the errors found had no clear policy guidance, he said.
"One problem across the board was there weren't monthly orders for delivery of backup oxygen tanks," said Shirvinsky. "There's no need for monthly delivery of tanks. The rules require we have the order in hand--given the urgent nature of supplying oxygen--but we have had program guidances that say we can deliver on the basis of a phone call. But, we cannot bill until we have the order in hand. Which is what these companies were doing."
The association was working with the state to address its concerns with the audit.
"It might just be that we have to get more definitive policy," said Georgie Blackburn, vice president of government relations and legislative affairs for Tarentum, Pa.-based Blackburn's.