“The Trump administration must press Congress to get new powers to penalize hospitals that submit incorrect payment data as a way to clamp down on Medicare and Medicaid fraud, the Department of Health and Human Services’ watchdog said.”
“HHS’ Office of Inspector General released a report on Tuesday outlining 25 previous recommendations to combat waste and fraud that have not been adopted by the Centers for Medicare & Medicaid Services.”
“Chief among the recommendations is that CMS should press Congress to get the authority to penalize hospitals that submit inaccurate or incomplete wage data via the hospital wage index, which is used to adjust Medicare payment rates to account for local differences in hospital wages…”
“Other key recommendations in the report include:
Providing targeted oversight of Medicare administrative contractors. OIG found back in December 2019 that billions of Medicare Advantage risk-adjusted payments are based solely on chart reviews. OIG questioned whether the payment data to CMS was complete and the validity of diagnoses on solely chart reviews. CMS said back in February it will release encounter data exchange reports later this year to require MAOs to provide written explanations for detect errors.
Creating a strategy to ensure that Part D doesn’t pay for drugs that should be covered under Medicare Part A’s hospice benefit…” Read the full article here.
Source: OIG: CMS must press Congress to overhaul Medicare’s hospital wage index to prevent fraud – By Robert King, August 11, 2020. Fierce Healthcare.
