CMS to Conduct ‘Audit Audit’

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.”