Senators push CMS to recoup improper Meaningful Use payments; physicians cry foul

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Republican Senators Charles Grassley and Orrin Hatch want to know why CMS has not made more progress in recouping $729 million in incentive overpayments.

Two Republican senators are asking the Centers for Medicare & Medicaid Services why the agency hasn't taken action to recoup $729 million worth of Meaningful Use incentive program overpayments.

As part of a program to encourage providers to shift to electronic health records, CMS incorrectly paid an estimated $729 million in incentive payments to healthcare professionals who did not actually meet Meaningful Use requirements between May 2011 and June 2014, according to the audit (PDF) by the Department of Health and Human Services' Office of Inspector General (OIG).

Physician groups have said they'll oppose attempts to collect these funds, saying CMS didn't tell doctors what evidence they needed to prove their eligibility.

In a letter (PDF) to CMS Administrator Seema Verma, Utah Senator Orrin Hatch and Iowa's Charles Grassley note that the agency has made no commitment to recover $729 million worth of inappropriate payments made to healthcare professionals. A recent OIG audit calculated the total amount of payments based upon a sample of 100 results.

“If CMS is capable of recovering taxpayer money that should not have been spent, the agency should take all reasonable steps to do so,” the senators write. “If it is incapable of fully recovering the money, Congress should know about those limitations."

The senators’ specific demands include:

  • An update on whether CMS has made any progress in collecting the $291,222 of improper payments detailed in the OIG audit;
  • an explanation regarding the agency’s lack of progress in pursuing the estimated $729 million in total overpayments;
  • information on recovery efforts regarding approximately $2.3 million in overpayments made to healthcare professionals who switched between Medicare and Medicaid, causing payments to be made for the wrong year;
  • an update on further investigations and actions taken to identify additional improper payments.

The senators also take issue with targeted audits implemented by CMS to improve the program’s integrity, which the OIG indicates do not address the errors it identified in its report.