Medicare has long been plagued with overpaying providers, and one of the primary duties of program integrity contractors is to collect the overpayments and return them to Medicare. However, this may not be happening, as evidenced by a recent report from the Health and Human Services Office of Inspector General.
Medicare administrative contractors tried to collect $482 million in overpayments that were referred to them in fiscal year 2014, but had only collected $96 million as of September 2015, the report said. The longer it takes to collect an overpayment, the more likely it is that the money will never be returned to Medicare.
It’s no secret that the Centers for Medicare & Medicaid Services overpayment collection process doesn’t work very well, Judith Waltz, a health-care attorney with Foley & Lardner LLP in San Francisco, told me. The CMS has a limited ability to deal with overpayments, Waltz said. It can recover overpayments, as long as the provider or supplier is still submitting claims, and it can refer overpayments to the Treasury Department for collection, but that’s about it, Waltz said.
“The Department of Justice has to step in for affirmative litigation, and for settlements over a set amount, the DOJ’s approval is required,” Waltz said. Affirmative litigation is required when providers or suppliers are no longer participating in Medicare, preventing the CMS from collecting any overpayments.
The report said the CMS should take several steps to improve both the identification and collection of overpayments, including sharing best practices among the contractors charged with identifying overpayments (Zone Program Integrity Contractors and Unified Program Integrity Contractors). The OIG also recommended implementing a surety bond for home health providers, a move that would ensure that at least some money would come back to the program in case of an overpayment.
The CMS agreed with most of the recommendations, but didn’t take any position regarding the surety bond requirement.
Read my full article here.
Stay on top of new developments in health law and regulation with a free trial to the Health Law Resource Center.
Learn more about Bloomberg Law and sign up for a free trial.
All Bloomberg BNA treatises are available on standing order, which ensures you will always receive the most current edition of the book or supplement of the title you have ordered from Bloomberg BNA’s book division. As soon as a new supplement or edition is published (usually annually) for a title you’ve previously purchased and requested to be placed on standing order, we’ll ship it to you to review for 30 days without any obligation. During this period, you can either (a) honor the invoice and receive a 5% discount (in addition to any other discounts you may qualify for) off the then-current price of the update, plus shipping and handling or (b) return the book(s), in which case, your invoice will be cancelled upon receipt of the book(s). Call us for a prepaid UPS label for your return. It’s as simple and easy as that. Most importantly, standing orders mean you will never have to worry about the timeliness of the information you’re relying on. And, you may discontinue standing orders at any time by contacting us at 1.800.960.1220 or by sending an email to email@example.com.
Put me on standing order at a 5% discount off list price of all future updates, in addition to any other discounts I may quality for. (Returnable within 30 days.)
Notify me when updates are available (No standing order will be created).
This Bloomberg BNA report is available on standing order, which ensures you will all receive the latest edition. This report is updated annually and we will send you the latest edition once it has been published. By signing up for standing order you will never have to worry about the timeliness of the information you need. And, you may discontinue standing orders at any time by contacting us at 1.800.372.1033, option 5, or by sending us an email to firstname.lastname@example.org.
Put me on standing order
Notify me when new releases are available (no standing order will be created)