Why OIG Did This Review
“We made a commitment in ourpreviousFraud Prevention System (FPS) work to assess why the FPS’s reported amounts that were reasonably expected to be prevented or recovered (adjusted savings) were such a small percentage of the FPS’s identified savings, particularly for overpayment determinations and law enforcement referrals. These payment recovery administrative actions have the most significant FPS adjustment factors (used to calculate adjusted savings from the identified savings) and account for a large share of the reported differences…”
What OIG Found
“The FPS’s adjusted savings for overpayment determinations and law enforcement referrals were approximately 10 percent of the identified savings for its second and third implementation years because (1) the Medicare administrative contractors’ (MACs’) opportunities to collect FPS-identified overpayments were often limited by both the time it took to get referrals from the Program Integrity Contractors and by unique challenges in attempting to recover overpayments from providers and (2) CMS has not established a standard process for the Program Integrity Contractors to estimate the value of law enforcement referrals…”
What OIG Recommends and CMS Comments
“We recommend that CMS (1) continue to work with the Program Integrity Contractors and the MACs to develop strategies that improve timely coordination to give the MACs a better opportunity to recover overpayments,(2) establish a uniform methodology for the Program Integrity Contractors to use when reporting estimates for the value of law enforcement referrals, and (3) update the FPS’s law enforcement referral adjustment factor.”
Access the full 27-page report here.
Source: The Centers for Medicare and Medicaid Services Could Improve Its Processes for Evaluating and Reporting Payment Recovery Savings Associated With the Fraud Prevention System – October 2019. OIG.
