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OIG recommends improvements to Medicaid claims review program

February 24, 2012

The Centers for Medicare & Medicaid Services should improve the quality of data available to contractors who review Medicaid claims for potential overpayments and fraud, the Department of Health and Human Services' Office of Inspector General concludes in a new report. Assessing the program's results for the first half of 2010, OIG found the Review Medicaid Integrity Contractors are hindered by missing and inaccurate data and have limited involvement in recommending specific audit leads. "States invalidated more than one-third of sampled potential overpayments from assignments, mainly because data were missing or inaccurate," the report states. CMS told OIG it has several initiatives underway to improve the quality of the data the Review MICs can access and will direct them to include specific recommendations for potential audit targets.