OIG report finds jump in redeterminations

Thursday, May 29, 2014

WASHINGTON – Medicare contractors processed 2.9 million redeterminations in 2012, an increase of 33% since 2008, according to the Office of Inspector General (OIG) semi-annual report to Congress. As a result, the OIG calls on CMS to use the Medicare Appeals Process to monitor contractor performance, share information and keep an eye on the quality of redeterminations data. Also in the report: the OIG says it expects more than $3.1 billion in recoveries—$295 million from audits and $2.83 from investigations. It cites 465 criminal actions and 266 civil actions, as well as the exclusion of 1,720 individuals from participation in federal health care programs. Additionally, the OIG identified $91.6 million in Part B improper payments to “unlawfully present beneficiaries” from 2009-2011; $33.6 million in uncollected Part A and B improper payments for incarcerated beneficiaries from 2009-2011; and $23 million in improper payments for dead beneficiaries in 2011.