April 25, 2019
The Government Accountability Office (GAO) recently unveiled a report criticizing the Center for Medicare and Medicaid (CMS)’s oversight of its medical documentation requirements. Finding over $23 billion dollars in inappropriate Medicare Fee-for-Service payments that could be attributed to deficiencies in documentation supporting claims in CY 2017, the report highlights just how Medicare’s burdensome and often complex documentation requirements may be inadvertently leading to improper payments. Similarly, the GAO found over $4 billion in inappropriate Medicaid payments were made over the same period of time.
The report is aimed at the oversight activities of the Medicare and Medicaid programs. However, the GAO specifically called out payments made to independent clinical diagnostic laboratories – citing a Medicare fee-for-service error rate greater than 28 percent compared to an overall error rate of 6.1 percent. Of the nearly $1 billion in inappropriate lab payments, nearly 90 percent were due to incomplete or insufficient documentation.
The full report is available here.