A government agency that lost an estimated $4.6 million isn’t interested in trying to recover it even though the federal watchdog that exposed the problem recommended going after the wasted funds.
The Centers for Medicare & Medicaid overpaid hospitals by an estimated $4.6 million for outpatients who visited the same clinic twice in a three-year period in 2012, according to the Health and Human Services Inspector General. The IG told CMS it should seek to recover the money, no matter the amount involved.
“We will not review all line items or providers,” CMS officials responded, refusing both to review the overpayments or try to recover the funds.
Likewise, another report released earlier in 2014 estimated that CMS made $7.5 million of incorrect payments for the same type of visits in 2010 and 2011 and similarly refused to correct the issue.
The actual total amount of incorrect payments could be substantially higher since CMS incorrectly paid almost all of the items the IG sampled in its recent audit.
“Of the 110 randomly sampled line items for … Medicare payments to hospitals for clinic visits for our audit period, one was correct,” the IG said.
The IG used the samples to represent nearly 200,000 payments worth a total of $19 million. The office’s spokesman, Don White said the sample size was valid for projecting losses.
“Statistically speaking, they only needed 100 [samples] for this report,” White said.
CMS was over-billed by the hospitals because patients either were coded as “new,” rather than returning, or for a more expensive service than what they received.
The hospitals blamed staff for clerical and programing errors, not verifying a patient’s history, improper procedures, lacking knowledge on Medicare billing requirements and neglecting to correct improper billing codes used by doctors.
CMS refused to review the line items, because they claimed they fixed the coding problem, effective January 2014. That response was rejected by the IG: “We do not believe it is relevant to the payments during our audit period. We maintain that we identified valid overpayments and that they should be recovered.”
Also, the center saw budget efficiency as an issue.
“The average overpayment is $24, yet it will cost CMS an average of $90 per claim to review,” CMS claimed. Such expensive reviews were unnecessarily comprehensive, and provided the center with little data on the line items in question, the IG countered.
Health and Human Services Inspector General by Hoai Tran Bui
