PHILADELPHIA — Responding to criticism from HME and hospital representatives about over-reaching audits, a high-ranking CMS official participating in a health care fraud summit June 17 said the agency would conduct an "audit audit."
According to a report from the American Association for Homecare, CMS' Peter Budetti, deputy administrator of the Center for Program Integrity, said the agency would investigate the merit of complaints about the growing number of audits.
"Who's guarding the guardians?" John Shirvinsky, executive director of the Pennsylvania Association of Medical Suppliers, asked Budetti during a Q&A at the Philadelphia summit. He likened the increasing audits to TSA airport screenings where "85-year-old grandmothers and toddlers are getting patted down."
AAHomecare's Regulatory Council has been working to address the increasing ferocity of audits and the inconsistencies across Medicare audit programs, which now include CERT, RAC, ZPIC and medical reviews. At a June 7 meeting with CMS officials, association representatives presented recommendations on what documentation should be requested for CPAP, oxygen, enteral nutrition, diabetic supplies, power mobility devices and nebulizers. The association also made recommendations to clarify how CMS auditors conduct audits.
The goal is to ensure that all audit contractors request consistent documentation that is appropriate and specified under each Medicare coverage policy, according to Kim Brummett, chairman of the association's Regulatory Council and vice president of Advanced Home Care, High Point, N.C. In an interview earlier this year, Brummett said the audit situation was "the worst I have ever seen. We have auditing bodies tripping over each other."
CMS Administrator Donald Berwick, who attended the daylong summit — where HHS and CMS announced a predictive modeling tool to stem health care fraud — admitted that audits are "a blunt tool," the association reported. Shantanu Agrawal, MD, the medical director for the Center for Program Integrity, commented, "We heard a lot of concerns about the number and frequency of audits, so we take that to heart."