Review of CMS's Action on CERT Data
Since 2003, Centers for Medicare & Medicaid Services has utilized the Comprehensive Error Rate Testing (CERT) program to establish a national error rate for Medicare Fee-for-Service payments as mandated by the Improper Payments Information Act of 2002. We issued a report in 2010 identifying error-prone providers and recommended that Centers for Medicare & Medicaid Services target these specific providers that contributed significantly to payment errors in the CERT program for provider-based reviews. Improper error rates and payments have not decreased in recent years. The FY 2015 reported national error rate for Medicare Fee-for-Service payments was approximately 12.1 percent, with improper payments estimated at $43.3 billion. We will determine if Centers for Medicare & Medicaid Services took action on our previous recommendation to use CERT data to target error-prone providers and reduce payment errors. Additionally, we will analyze CERT data to identify errors and potential patterns where further interventions could reduce payment errors.
|Announced or Revised
|Expected Issue Date (FY)
|Review of Centers for Medicare & Medicaid Services Action on CERT Data
|Office of Audit Services