Centers for Medicare & Medicaid Services’ Use of Medicare Fee-for-Service Error Rate Data To Identify and Focus on Error-Prone Providers

From the Executive Summary

The Improper Payments Information Act of 2002 requires the head of a Federal agency with a program that may be susceptible to significant improper payments to report to Congress the agency’s estimate of the improper payments. During our audit period, fiscal years (FY) 2005 through 2008, CMS used two programs to estimate improper Medicare fee-for-service (FFS) payments: the Hospital Payment Monitoring Program (HPMP) and the Comprehensive Error Rate Testing (CERT) program.

We found that CMS and its contractors did not use historical HPMP and CERT error rate data to identify and focus on error-prone providers. We defined “error-prone providers” as providers that had at least one error in each of the 4 years of our audit period. Although payment contractors developed corrective actions based on the HPMP and CERT error rate data, they typically did not focus on error-prone providers for review and corrective action.

 

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