What We Found

In FYs 2010 and 2011, RACs identified half of all claims they reviewed as having resulted in improper payments totaling $1.3 billion. CMS took corrective actions to address the majority of vulnerabilities it identified in FYs 2010 and 2011; however, it did not evaluate the effectiveness of these actions. As a result, high amounts of improper payment may continue. Additionally, CMS did not take action to address the six referrals of potential fraud that it received from RACs. Finally, CMS's performance evaluations did not include metrics to evaluate RACs' performance on all contract requirements.

Source: United States Department of Health and Human Services. (2013). Medicare Recovery Audit Contractors and CMS's actions to address improper payments, referrals of potential fraud, and performance. Retrieved from http://oig.hhs.gov/oei/reports/oei-04-11-00680.pdf(Links to an external site.)

1. What would be your recommendations to CMS for complying with the findings of this study?