Using comprehensive error rate testing program data, the inspector general identified 100 “error-prone” providers from 2014 through 2017. Of $5.8 million reviewed, $3.5 million was incorrect, an improper payment rate of 60.7 percent. From 2014 through 2017, Medicare made $19.1 billion in payments to the 100 “error-prone” providers, according to the OIG.
Based on its findings, the inspector general recommended that CMS review the list of 100 providers and “take specific action” such as prior authorization, prepayment and postpayment reviews. The report also recommended that CMS use annual comprehensive error rate testing data to identify providers that have an increased risk of receiving improper payments and apply more program integrity tools to them.
In written comments on the draft report, CMS did not agree with the inspector general’s recommendations. CMS also disagreed with the inspector general’s methodology for identifying error-prone providers. CMS said it has tried to use comprehensive error rate testing data to identify error-prone providers but found that the data was ineffective for this purpose.
After reviewing CMS’ comments, the inspector general maintained its findings and recommendations.
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