By John Ballard
A proposed rule from the Centers for Medicare & Medicaid Services to review Medicare overpayments, dating back to as far as 10 years, could mean undue administrative burdens and costs for health care providers.
The proposal rule, published in the Federal Register Feb. 16, requires that providers and suppliers must report and return self-identified overpayments within 60 days. Before the Affordable Care Act, providers didn't have a set deadline for returning taxpayers' money, but under the Act, there will be a specific time frame by which overpayments must be returned, CMS explained in a statement last month. And providers who fail to report and return the overpayment within that time frame could be violating the False Claims Act and face civil monetary penalties or be excluded from the federal program altogether.
Also under the proposed rule, CMS plans to broaden the look-back period of Medicare overpayments from what is generally four years to up to 10, HealthLeaders Media reported. The expanded time frame could cost as much as $58 million in reporting-related expenses per year for about 125,000 providers and suppliers, the article noted.
Calling it "overkill," Amy E. Nordeng, government affairs counsel for the Medical Group Management Association, said the CMS rule, if enacted, could be particularly burdensome for group practices who might not have billing records that far back.
The other issue at hand is that providers who are overpaid might not be intentionally violating the False Claims Act but rather committing billing errors. "[Ten years] would be under the worst case scenario under the False Claims Act when in fact most of the time when there is some kind of billing error it is just that-an error," Michael Gennett, counsel at Miami-based Akerman Senterfitt Law Firm, said in the article. "It is not a knowingly false claim."
For example, in an Office of Inspector General report released Tuesday, University of California, San Diego, Medical Center complied with Medicare billing requirements for 111 of the 210 inpatient and outpatient claims the OIG audited. But for the other 99 claims, UCSD was overpaid $351,000 for 2008 and 2009. OIG determined that the cause was primarily because the hospital's existing controls did not adequately prevent incorrect billing of the claims. After the audit, the hospital implemented educational programs, leveraged technology, and redesigned the audit and billing process to ensure compliance.
CMS' proposed rule, although worrisome, might not be surprising to providers. The agency has taken a hard-line stance against fraud and waste. CMS already has recovered approximately $5 million in overpayments, the agency said.
Looks like the folks at CMS are catching up with investigative journalists who have been putting out stories about fraud and abuse for years. The president's opponents sometimes claim this administration isn't doing enough to save money and in the next breath complain about too many regulations and too much government oversight interfering with the private sector. Here are a few links to think about next time you hear that kind of nonsense.
- OIG: Home health has 'limited' oversight, reporting
- Hospital CEO sued for allegedly embezzling $850K
- Dimensions president resigns after internal investigation of kickbacks
- FBI gains $1.2B in healthcare fraud restitution
- Hospital seeks repayments from docs after fraud settlement
- State to start anti-Medicaid fraud verification without fed approval
It's like shooting fish in a barrel. Makes me wonder why it has taken so long. I think it has to do with the Reagan Revolution and an asleep-at-the-switch culture that pervaded Washington beginning with his famous "government IS the problem" pronouncement.
All that complaining about a ten-year lookback is baloney. Anyone who has been downwind of anything having to do with healthcare knows that record-keeping may be more important than blood banks and sanitation. Anybody who has ever been on the receiving end of an insurance claim challenge knows that. If you took a pee at the wrong time a few years ago somebody took note of it and there will be a document to prove it. And when it comes to billing you can bet your last dollar if the record is lost it's because they didn't want it found.
With this year's presidential election turning into a GOP Suicide Watch I'm starting to think some of the positive trends started under the Obama administration may have time to take root and grow. One can hope.