A report issued this week by the Office of the Inspector General at the U.S. Department of Health and Human Services found that $91.6 million was paid to Medicare providers for services rendered to 2,575 unlawfully present aliens between 2009 and 2011. For home health, the figure totaled $3.87 million over the same period ($2.1 million in 2009, $1.2 million in 2010, $458,862 in 2011).
The report found that the Centers for Medicare & Medicaid Services did not have policies and procedures that would have enabled it to detect such improper payments after the payments were made. Consequently, CMS did not notify the Medicare contractors to recoup any of the $91,620,548 in improper payments.
As of result of the report’s findings, OIG recommended that CMS:
- ensure that Medicare contractors recoup the $91,620,548 in improper payments,
- implement policies and procedures to detect and recoup improper payments made for Medicare services rendered to unlawfully present beneficiaries in cases when information relating to unlawful presence is received on previously paid Medicare claims, and
- identify improper payments made on behalf of unlawfully present beneficiaries after our audit period but before implementation of policies and procedures and ensure that Medicare contractors recoup those payments.
CMS concurred with OIG’s last two recommendations and stated that in April 2013 it plans to implement a process for detecting and recouping improper payments for previously paid Medicare claims. CMS partially concurred with OIG’s recommendation regarding the recoupment of the $91,620,548 in improper payments. CMS stated that it is committed to recovering the overpayments OIG identified, but it must take into account the cost benefit of recoupment activities, including potential appeal costs and the cost of manually reopening these claims. CMS has initiated recovery actions for CY 2009 claims and is beginning to recoup improper payments for CY 2010 and 2011 claims as well.
Click here to read the report.
