CMS Must Change MAC Oversight Criteria

A new OIG report has found that CMS must change the way it monitors the Medicare Administrative Contractor (MAC) program after discovering that MACs failed to meet a quarter of the government’s quality assurance standards. CMS also did not have action plans for 12 percent of these unmet standards. MACs did meet the majority of the 1,201 quality assurance standards but the OIG report found that it failed to meet 310, or 26 percent, of these standards.  MACs also failed to resolve 83, or 27 percent, of those unmet standards.

OIG noted that CMS “has limited ability to solicit and award new contracts under the current time frame when MACs fail to meet the agency’s requirements” and has recommended steps to improve the monitoring of the program. CMS agreed with all recommendations.

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