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 House Committee Asks Whether CMS’ Hired Guns Are Shooting Straight

The House Energy & Commerce Committee has called for a review of the private companies used by the Centers for Medicare & Medicaid Services (CMS) to root out waste and corruption.

The committee wants “to ensure” that the contract auditors “are working efficiently and effectively while guaranteeing that beneficiaries are receiving care to which they are entitled,” committee leaders said in a letter Tuesday to the Government Accountability Office (GAO).

The committee wants to make sure that the various audit regimes, including the controversial Zone Program Integrity Contractors (ZPICs), are zeroing in on waste and abuse but are not “unnecessarily burdensome to providers,” the letter said.

GAO’s new review is a victory for long term care providers, who had complained roundly that the ZPIC audits were a blunt instrument that was harming cleanly run providers in the hunt for wayward operators.

The American Health Care Association greeted Tuesday’s announcement with relief, and hope, that congressional review would bring some clarity to what had become a scattershot ordeal.

“These contractors play an important role in the Medicare payment structure,” the association said in a statement. “But their effectiveness—and credibility—suffer if they lack coordination and a clear set of rules they want providers to follow. Our members aren’t even sure who’s in their buildings most of the time. There must be a better way. That begins with a clear set of standards with reasonable timelines and better communications with our providers.”

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