“In a previous review, the Office of Inspector General (OIG) determined that the Centers for Medicare & Medicaid Services (CMS) had recovered the majority of Medicaid overpayments that we had identified in audit reports issued during Federal fiscal years (FYs) 2000 through 2009. However, millions of dollars remained uncollected at the time we issued our report. We performed the current audit as a followup to the previous audit. Specifically, we wanted to determine whether CMS has recovered the remaining amounts that we identified as uncollected in the previous review, as well as Medicaid overpayments identified in OIG audit reports issued in FYs 2010 through 2015…”
“What OIG Found
CMS had not recovered all of the overpayments identified in OIG audit reports in accordance with Federal requirements. Specifically, CMS did not collect $1.6 billion in overpayments identified in 77 current period audits and $188.6 million in overpayments identified in 7 prior period audits. CMS is in discussions with State officials regarding 26 reports and 51 outstanding overpayments that continue to be in the disallowance process. In addition, CMS did not ensure that States correctly reported Medicaid overpayments on the Quarterly Medicaid Statement of Expenditures for the Medical Assistance Program Form CMS-64 (CMS-64). Finally, we could not verify the accuracy of $2.7 million that CMS told us was reported by States because before our review CMS disposed of documents supporting that overpayments were recovered…”
“What OIG Recommends and CMS Comments
We recommend that CMS recover the remaining $1.6 billion due the Federal Government from the current period and $188.6 million due the Federal Government from the prior period and improve the timeliness of recovering overpayments by setting guidelines about the time CMS has to work with States to obtain documentation and issue disallowance letters to States. We also recommend that CMS verify that States report overpayments correctly, require States to resubmit corrected CMS-64s when they do not, and continue to educate States about their responsibility to report overpayments correctly…”
Source: The Centers for Medicare & Medicaid Services had not Recovered more than a Billion Dollars in Medicaid Overpayments Identified by OIG Audits – December 2018. OIG.
