February 21, 2013

Millions of Medicaid Overpayments Uncollected; Lack of Adequate Documentation Cited

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Washington, D.C.—Recognizing that the Centers for Medicare & Medicaid Services (CMS) had collected the majority of Medicaid overpayments, the U.S. Department of Health and Human Services’ Office of Inspector General reported yesterday that $225.6 million remains uncollected because CMS had not collected the overpayments in a timely manner from the states.

In the report posted to its website, the OIG said CMS had collected $987.5 million of the $1.2 billion in what the agency identified as “sustained” Medicaid overpayments—overpayments sustained in 147 audit reports as of December 2012. The $225.6 million related to overpayments the OIG had previously identified in 10 audit reports showing the states had not agreed to refund the money.

Additionally, noted the OIG in its report, CMS could not document that $7.2 million it had reported as collected actually had been collected, noting the agency could not do so because, as CMS acknowledged and the OIG reported, “CMS did not maintain adequate supporting documentation.”

Part of the problem, as uncovered by the OIG, was that CMS did not adequately instruct the states on how to complete properly Form CMS-64,that would have allowed the OIG to track the recoveries. In this case, states reported the overpayments on an incorrect line on the form.

Among the OIG’s four recommendations, according to its report, CMS “partially concurred with (its) our first recommendation,” that it collect the remaining $225.6 million.

EDITOR’S NOTE:  Deputy Inspector General Gloria Jarmon from the OIG’s Office of Audit Services will appear on Monitor Monday, March 18 at 10 AM ET. Register to listen.

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Chuck Buck is publisher of RACmonitor.

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Download the OIG Report

http://go.usa.gov/4uRR

Chuck Buck

Chuck Buck is the publisher of RACmonitor and is the program host and executive producer of Monitor Monday.

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