Inspector General pushes CMS to recover $226M in Medicare overpayments

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 55% of the $498 million in overpayments the OIG identified 2018.

CMS has clawed back $226 million in overpayments, but the inspector general found proper documentation for only $120 million of it, the report says.

In addition, the OIG 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 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.

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CMS didn’t respond to a request for comment.

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