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Status of 244 Provider Audits Identified Using Review Medicaid Integrity Contractor Analysis


This memorandum report is intended as an addendum to our February 2012 report, Early Assessment of Review Medicaid Integrity Contractors (OEI-05-10-00200), in which we identified concerns with the quality of Review Medicaid Integrity Contractor (MIC) analysis. The effect those quality concerns could have on audit outcomes served as the impetus for issuing this memorandum report. That report and this memorandum report are an early assessment of Review MICs' program integrity activity results.


Using CMS's tracking database, we determined whether each audit target was assigned to an Audit MIC and whether each assigned audit was completed or ongoing as of February 1, 2012. For the purposes of this review, we considered audits to be complete if they resulted in a report or were discontinued by CMS. For completed audits, we used the most recently reported estimate of actual overpayments to calculate the monetary results.


Ultimately, Review MIC analysis from assignments made between January and June 2010 led to 25 completed audits, with actual overpayments totaling $285,629. Review MICs had initially identified 113,378 providers with potential overpayments, and CMS had reviewed these 113,378 providers and selected 244 as audit targets. CMS assigned 161 of these 244 audit targets, with $33.5 million in potential overpayments, to Audit MICs.

This memorandum report does not contain recommendations.