Home Health & Hospice Week

When the feds decide you owe the government money, they want it paid back ASAP.

A new report from the HHS Office of Inspector General suggests the Centers for Medicare & Medicaid Services can do more to take back money identified as owed in an audit, and CMS says it will do it.

The problem: “CMS did not always resolve audit recommendations in a timely manner” in the fiscal years studied, 2015 and 2016, the OIG says in its new report on resolving audit recommendations.

“Specifically, CMS resolved 1,231 of the 1,371 recommendations that were outstanding during FYs 2015 and 2016. However, it did not resolve 405 of the 1,231 recommendations (32.9 percent) within the required 6-month resolution period.” The 140 audit recommendations that were past due for resolution in September 2016 “had associated dollar amounts that totaled $138.6 million,” the OIG added.

The OIG did give CMS credit for improving its audit resolution rate from previous years, however. While one-third of the 2015/2016 recommendations were not resolved in the six-month period, in FYs 2006/2007 81.2 percent were not resolved in the six-month period.

In addition to that “48 percentage point increase in the number of recommendations resolved within the required six month window … CMS also reduced the total dollar amounts associated with unresolved recommendations from 1.17 billion to 139 million dollars,” pointed out CMS Administrator Seema Verma in CMS’s response to the OIG’s report.

Verma patted CMS on the back for the improvement, noting that “CMS continues to strengthen and refine its audit processes to ensure that all audit recommendations are resolved timely thus continuing to strengthen our stewardship over Federal dollars,” according to the response letter. Specific changes include dedicating staff “responsible for ensuring audit recommendations are resolved on a timely basis” and implementing “stronger internal controls,” Verma continues. Those controls include strengthening CMS’s reconciliation process and its detailed audit resolution procedures, as well as introducing a new audit recommendation resolution tracking system with improved audit tracking and reporting features.

CMS also already had resolved 97 of the 140 past-due audits, and “expects to submit documentation to OIG on the remaining 43 recommendations by early 2019,” Verma told the OIG in the response.

The solution: The OIG urges CMS to follow and enhance its current policies and procedures on audit resolutions “to ensure that all management decisions are issued within the required 6-month resolution period,” according to the report. CMS agrees to do so.

The 21-page report is at https://oig.hhs.gov/oas/reports/region7/71803228.pdf.