CMS To Require State Audits Of Providers Accepting Medicaid

The Centers for Medicare & Medicaid Services will require all states to audit health care providers participating in Medicaid to address alleged fraud. In response to this federal requirement, the Department of Social Services released information on potential upcoming audits by CMS and their contractor, CoventBridge. In consultation with the MO HealthNet Division and Missouri Medicaid Audit and Compliance, CoventBridge may randomly select a number of providers to participate in the upcoming audit. DSS outlines the Medicaid provider’s responsibilities to comply with this audit as follows.  

1. Respond to Records Requests: If you receive a written request from CoventBridge for medical records relating to sampled claims, you are required to respond within the timeframe specified in the request. Timely submission is essential to avoid compliance issues. 

2. Legal Compliance: Under the Deficit Reduction Act and other applicable federal and state laws, providers are legally obligated to furnish the requested medical records. Records may be released under HIPAA for Health Oversight Activities authorized by law under 45 CFR 164.512(d). Failure to comply may result in administrative actions as outlined in 13 CSR 70-3.030. 

3. Staff Awareness: Please ensure your administrative staff is aware and understands that correspondence from CoventBridge is official and requires prompt attention.