CMS failed to col­lect 80% of over­pay­ments, au­di­tors say

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Fed­eral au­di­tors found that the CMS failed to col­lect about 80% of the $416 mil­lion that was specif­i­cally iden­ti­fied as over­pay­ments in prior au­dits. Fur­ther­more, au­di­tors said the CMS could not prove that the 20% said to be col­lected was ac­tu­ally re­ceived. In re­sponse, the CMS said that just over half of the over­pay­ments iden­ti­fied by HHS’ in­spec­tor gen­eral’s of­fice was in­cluded in au­dits that were re­leased af­ter the statute of lim­i­ta­tions had ex­pired for re­open­ing the claims, mak­ing col­lec­tions im­pos­si­ble un­der cur­rent laws and reg­u­la­tions. But the agency pledged to strengthen its sys­tems. “We are com­mit­ted to col­lect­ing over­pay­ments in Medi­care and Med­i­caid, and we are work­ing to im­prove track­ing and re­port­ing, and co­or­di­nat­ing with OIG to bet­ter iden­tify over­pay­ments be­fore the look-back pe­riod has passed,” a CMS spokesman said in an e-mail. The in­spec­tor gen­eral’s of­fice said in a 26-page re­port that the CMS pledged to col­lect $416 mil­lion in over­pay­ments iden­ti­fied in 154 au­dits be­tween 2007 and 2009, yet $332 mil­lion re­mained un­col­lected as of Oc­to­ber. The CMS agreed with a rec­om­men­da­tion by the au­di­tors to “pur­sue leg­is­la­tion” to ex­tend the time when au­di­tors can re­cover Medi­care over­pay­ments. Au­di­tors also crit­i­cized the CMS’ ex­pla­na­tions that its out­side con­trac­tors had ac­tu­ally col­lected the $84 mil­lion they claimed. CMS of­fi­cials said they took con­trac­tors’ re­ports of bud­get ad­just­ments as proof of col­lec­tions, but au­di­tors said they could not ver­ify the money had been re­ceived.

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