Tag: Government Accountability Office (GAO)
GAO to CMS: Conduct fingerprint-based background checks
January 12, 2023HME News Staff
WASHINGTON – CMS needs to address risks posed by provider enrollment waivers and flexibilities that have been in place during the COVID-19 pandemic, the Government Accountability Office says in a new report. The GAO analyzed 47 waivers and flexibilities, such as waivers of about 7,300 fingerprint-based background checks for types of providers posing a high risk of fraud, waste and abuse, and found that Medicare took some steps to oversee providers but fell behind in others. In all, the GAO...
GAO on telehealth and other waivers: ‘Careful monitoring is warranted’
May 24, 2021HME News Staff
WASHINGTON – Members of the Government Accountability Office testified before Congress last week saying, while Medicare beneficiaries and providers have benefitted from program waivers and other flexibilities, their continued use beyond the pandemic increases risks and raise considerations.
Among those risks and considerations:
Increased spending: Telehealth waivers can increase spending in both Medicare and Medicaid, if telehealth services are furnished in addition...
GAO sides with CMS on impact of bid program
August 28, 2018HME News Staff
WASHINGTON - The average reduction in payment rates in non-competitive bidding areas for five DME items with the highest expenditures in 2016 was 46%, according to a new report from the Government Accountability Office.
In its review of the effects of reduced payment rates in non-bid areas, the GAO also found that: the number of suppliers furnishing rate-adjusted items in non-bid areas in 2016 decreased 8% compared to 2015; and beneficiary utilization of rate-adjusted items in non-bid areas in...
GAO sides with C2C on QIC contract
August 24, 2018HME News Staff
WASHINGTON - The Government Accountability Office agrees that CMS failed to properly assess “potential organizational conflict” when the agency awarded Maximus the DMEPOS QIC contract. The GAO's decision* comes after C2C Solutions, the current QIC contractor, protested the award. The GAO's decision sustains C2C's protest. “Protest that the agency failed to evaluate a potential impaired objectivity organizational conflict of interest is sustained where the awardee's...
GAO pokes holes in CMS's MA audit program
May 10, 2016HME News Staff
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...
Stakeholders challenge OIG
January 16, 2015Liz Beaulieu, Editor
WASHINGTON - The Office of Inspector General (OIG) says it will use Medicare claims data to review the impact of competitive bidding on beneficiary access to DME, but industry stakeholders don't want the agency to stop there.
“If our industry is allowed to provide the information that we have been collecting for fair judgment, we are hopeful that the OIG would come to the same conclusion that the bid program has negative impacts on beneficiaries,” said Kelly Turner, director of...
New DME RAC program on hold
January 15, 2015HME News Staff
WASHINGTON - Performant Recovery has filed a Government Accountability Office (GAO) bid protest against CMS.
The protest, filed Jan. 6, comes on the heels of the agency's announcement that it had selected Connolly as the recovery audit contractor (RAC) to oversee the national program for DME, home health and hospice.
Wilton, Conn.-based Connolly is the current RAC for Jurisdiction C, while Performant Recovery in Livermore, Calif., is the contractor for Jurisdiction A.
The national...
Price raises bidding issues at hearing
May 2, 2014HME News Staff
WASHINGTON - Rep. Tom Price, R-Ga., pressed Kathleen King, director of the Government Accountability Office (GAO), to explain CMS's conclusion that the competitive bidding program has had no negative impact on beneficiaries during an April 30 Ways and Means Health Subcommittee hearing on waste, fraud and abuse. The GAO released a report on the program April 18 that drew its conclusions largely on information provided by CMS. During his questioning, Price learned that CMS had not conducted clinical...
GAO supports delay in RAC fees
May 1, 2014HME News Staff
WASHINGTON - The Government Accountability Office (GAO) this week signed off on Medicare's plan to pay RACs for audits of hospitals only if a second-level appeals judge upholds their findings, according to news reports. The change is one of several that CMS plans to put in place as part of signing on a new group of RACs in 2014. “At this point, I do not think that the change will impact how much the RACs get paid, since appeals to the first and second levels are almost always decided...
GAO analyzes bid program's impact
April 9, 2014HME News Staff
WASHINGTON - The number of both beneficiaries and DME suppliers declined in Round 1 competitive bidding program areas in 2012, according to a new report issued yesterday by the Government Accountability Office (GAO).
To conduct its study, the GAO compared Medicare claims data from 2011 and 2012 with 2010 for beneficiaries; and compared claims data for 2012 with 2010 for contract and non-contract suppliers. For monitoring purposes, CMS had selected nine “comparator” areas that were...