The Centers for Medicare & Medicaid services has failed to collect about $226 million in Medicaid overpayments to 11 states, according to a report from the Office of Inspector General.
While CMS successfully reclaimed $1 billion in Medicaid overpayments, the agency failed to respond quickly enough to recover the remaining cash, the OIG noted. CMS has up to one year from the date of overpayment discovery to recover, or attempt to recover, the overpayment before adjusting the federal refund of state payments.
CMS said it did not immediately collect some overpayments because the resolution needed more review, according to the report.
In addition to collecting the overpayments, OIG recommended CMS follow standard procedures in documenting its collection attempts, and educate states about their responsibility to report overpayments "on the correct line" of the required form.
Overpayments to Indiana, Illinois, Kansas, Louisiana, Missouri, New Jersey, Oregon and Pennsylvania were highlighted in the report, according to a post in the OPGA Blog Government Effects. CMS already is working to collect overpayments to Medicaid providers in Florida, New York and Massachusetts.
In October, the American Hospital Association claimed rules for providers to report and repay Medicare overpayments were burdensome.
Last April, MedStar Georgetown University Hospital was cited by Medicare for overbilling Medicare $659,000. The hospital did not adequately control billing and coding of claims or fully understand billing requirements, OIG reported.
To learn more:
- read the Office of General Inspector report
- read the OPGA blog post about the report
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