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CMS, OIG Disconnect Highlighted In Medicare Overpayments Report

Federal watchdogs reported the Facilities for Medicare & Medicaid Companies (CMS) has not collected the near-$500 million in Medicare overpayments that have been present in audits over a two-year interval starting in 2014.

The Workplace of the Inspector Common on the Division of Well being and Human Companies (OIG-HHS) just lately reviewed 148 Medicare audits it performed for 30 months between 2014 and 2016 and will solely confirm that CMS collected $120 million of the $498 million in overpayments.

CMS, alternatively, stated it collected a complete of $272 million – 55% – however OIG couldn’t affirm CMS collected the remaining $152 million as a result of CMS “didn’t present enough documentation to help” that it collected the remainder, based on OIG.

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Furthering the disconnect between the 2 businesses, CMS solely carried out certainly one of 9 suggestions made by OIG following the most recent audit and report.

OIG had really helpful — amongst different issues — that CMS proceed its efforts to get better the remainder of the $226 million in overpayments, decide which portion of the $152 million was collected and recorded in its accounting system and develop a plan to resolve value report points that the OIG discovered.

CMS solely agreed to the primary suggestion.

“CMS usually didn’t concur with our findings or suggestions,” the OIG wrote in a press release. “Of our 9 suggestions, CMS concurred with one suggestion, didn’t concur with seven suggestions, and didn’t explicitly state that it concurred or didn’t concur with one suggestion.”

OIG additionally famous that CMS didn’t take corrective motion in response to suggestions made following the same audit again in 2009.

In that audit, OIG reported CMS had not recovered $332 million of the $416 million in Medicare overpayments in an similar 30-month interval that resulted in March 2009.

For now, OIG will replace its information to indicate that CMS collected $272 million, however is requesting detailed documentation for the total quantity.

“After reviewing CMS’ feedback, we preserve that our findings and suggestions are legitimate,” the OIG wrote.

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