OIG: CMS failed to recoup Medicare payments from illegal immigrants

Insurance claims forms

The Centers for Medicare & Medicaid Services failed follow internal procedures designed to recoup improper Medicare payments from illegal immigrants, leading to more than $9 million in overpayments, but government officials questioned the feasibility of going after the money.

CMS systems were able to prevent payments to “unlawfully present” individuals; however, claims that managed to slip through that process often went undetected or unenforced, according to a report released by the Office of Inspector General. In many cases, CMS discovered that claims were improperly paid, but did not instruct Medicare contractors to recoup the money.

CMS pays Medicare claims for U.S. citizens and U.S. nationals, as well as immigrants that are “lawfully present" in the U.S.

Often, when claims were found to be processed improperly, CMS determined that the providers were not at fault since they had relied on information presented by CMS. Therefore, the beneficiaries, rather than the providers, should be the target of recoupment. CMS agreed to claw back the $9.2 million in overpayments identified by the OIG, but noted that it was still “reviewing the feasibility of pursuing recoupment” from those individuals.

The report represents a marked improvement from previous reports. In 2013, the OIG reported that Medicare paid $91.6 million in Medicare claims for illegal immigrants in 2011. In 2014, President Obama released steps to prevent illegal immigrants from accessing Medicare coverage, including explicitly requiring proof of citizenship.