Home Health & Hospice Week

Watch out: The GAO wants RACs to have even more teeth. So says a Government Accountability Office in recent congressional testimony.

GAO recommends that the Centers for Medicare & Medicaid Services “seek legislative authority to allow Recovery Auditors to conduct prepayment claim reviews, which are generally more cost effective than postpayment reviews in preventing improper payments,” U.S. Comptroller General Gene L. Dodaro said in prepared testimony for an April 16 Energy and Commerce Subcommittee on Oversight and Investigations hearing.

Dodaro noted that home health oversight played an important part in CMS’ “considerable progress in reducing Medicare fee-for-service improper payment rates,” adding that “CMS has cited updates to documentation requirements for home health agency services that took effect in 2015 as a key change in helping reduce the Medicare fee-for-service improper payment rate,” according to the testimony titled “MEDICARE AND MEDICAID: Additional Actions Needed to Enhance Program Integrity and Save Billions.”

Specifically: “CMS began allowing additional types of documentation, such as provider notes, to support the medical necessity of home health services,” Dodaro specified in the testimony at www.gao.gov/assets/d24107487.pdf.

Inspector General Christi Grimm also testified in the hearing. Grimm’s testimony focused more on durable medical fraud, but she did ask for funding to boost fraud-fighting activities for all.

“The vast sums of money at stake heighten the risk of improper payments and attract criminals,” Grimm noted in prepared testimony. “We must counter sophisticated threats to HHS programs and meet an ever-rising demand for the oversight and enforcement that is needed to identify and mitigate risks of improper payments, protect programs and people from harm, and hold wrongdoers accountable,” she insisted.