OIG: Enhancements needed to collect overpayments

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Thursday, October 5, 2017

WASHINGTON – The MACs collected only 20% of Medicare overpayments referred by ZPICs and PSCs in 2014, says a new report from the Office of Inspector General.

The ZPICs and PSCs referred $559 million in overpayments in 2014, but the MACs sought $482 million and collected only $96 million, according to the OIG.

The ZPICs and PSCs send the highest number of referrals for Part B (60%) and DME (26%). They sent the highest dollar amount of referrals, however, for home health and hospice (43%), the OIG found.

In its defense, the MACs say collecting overpayments is problematic if: the provider is no longer in business, filed for bankruptcy or was revoked from participating in Medicare.

To increase collections, the OIG says CMS should implement the surety bond requirement for home health providers and consider a similar requirement for other providers based on their level of risk.

The OIG also recommends CMS create a standard report form for all contractors and require them to use a unique identifier for each overpayment.

CMS concurred with all of the OIG’s recommendations, except the surety bond requirement. The agency says it is evaluating how to implement such a requirement without causing undue provider burden.