Home Health & Hospice Week

A federal watchdog agency is serving up a list of problematic providers to audit on a silver platter, but so far the Centers for Medicare & Medicaid Services and its contractors aren’t biting.

Using Comprehensive Error Rate Testing data from 2014 through 2017, the HHS Office of Inspector General selected 100 error-prone providers. They racked up an improper payment rate of more than 60.7 percent and Medicare paid them $19.1 billion in fee for service payments, the OIG says in its new report, CMS’s Use of Comprehensive Error Rate Testing Program Data (A-05-17-00023).

Five of the 100 providers were home health agencies, while none were hospices, the OIG details in the report.

The result: “CMS and its contractors did not use CERT data to identify and focus on error-prone providers for review and corrective action,” the OIG found.

When the OIG urged CMS to do so in its draft report, CMS swatted down the recommendation. “CMS does not believe the OIG methodology for identifying error-prone providers and suppliers is valid,” said then-CMS Administrator Seema Verma in comments on the report. “CMS previously attempted to use CERT data to identify error-prone providers and suppliers, but found that CERT data was ineffective for this purpose and discontinued the practice.”

Why? “The CERT sampling methodology meets the Medicare FFS program precision requirements … [but] provider and supplier level improper payment rates do not have similar precision requirements,” Verma explained. “Also, relying solely on CERT claims to identify error-prone providers and suppliers artificially restricts the universe of providers and suppliers being scrutinized.”

Further, CMS “currently identifies error-prone providers and suppliers through a variety of methods,” Verma told the OIG. “CMS utilizes a centralized vulnerability management process to identify, prioritize, track, and mitigate vulner­abilities that affect the integrity of federal health programs.” And Medicare contractors have more up-to-date data than the CERT data, Verma added.

The 22-page report is at https://oig.hhs.gov/oas/reports/ region5/51700023.pdf.