GAO: CMS, MACs Should Bolster Provider Education to Cut Improper Medicare Payments

In 2016, an estimated $41.1 billion in improper Medicare fee-for-services payments were made to providers. The Centers for Medicare & Medicaid Services (CMS) believes that provider education plays an important role in ensuring payments are made properly; CMS has delegated authority for provider education to the Medicare Administrative Contractors (MACs).

In a recent report, the Government Accounting Office (GAO) found that contrary to federal internal control standards, CMS has not required the MACs to report on specific provider education efforts, which left certain areas vulnerable to improper billing. In addition, CMS has not required the MACs to educate providers who refer patients for durable medical equipment, prosthetics, orthotics, and supplies (DMEPOS) and home health services on supporting billing documentation and referral documentation, also contrary to federal internal control standards.

The GAO recommended...

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