The Centers for Medicare and Medicaid Services has failed to recoup hundreds of millions of dollars in Medicare overpayments, an independent federal watchdog reported Monday.
The Office of Inspector General at the Department of Health and Human Services conducted an audit and found that CMS has only recovered $272 million of the $498 million in overpayments the OIG identified 2018, but the inspector general located proper documentation for just $120 million of it, the report says.
The OIG recommends CMS recoup the remaining $226 million, standardize how it records transactions and provide contractors with specific guidance on how to relay financial information to the agency.
The OIG additionally notes CMS failed to complete recommendations, outlined in past performance reviews, that were meant to limit overpayments and improve claims tracking. CMS should document reasons for not collecting overpayments, accurately record transactions and provide financial oversight to contractors that provide collection services, the inspector general advises.
"The combination of a substantial balance of uncollected overpayments, inadequate policies and procedures, and unimplemented recommendations increases the risk that CMS will not collect millions of dollars owed to the Medicare trust funds," the report says.
The figures in the OIG report are out of date, CMS has collected 75% of the $498 million and continues to seek more, an agency spokesperson wrote in an email.
CMS also refuted other aspects of the inspector general's report and defended the information it supplied to the investigative body.
"Rather than CMS collecting detailed documentation or screenshots of the thousands of payment transactions that the Medicare contractors perform in the accounting system to collect overpayments, CMS often collects high-level summary updates and extracts, while the source documentation supporting the summary reports are maintained by the Medicare contractors," the spokesperson wrote.
