Obstacles to Collection of Millions in Medicare Overpayments

Oig.hhs.gov: 05-18-2012

Our review focused on overpayments that CMS had made and that OIG had recommended for collection. CMS agreed to collect, or “sustained” these overpayments. We selected OIG audit reports on Medicare with recommendations to collect overpayments greater than $1,000 that were issued during fiscal years (FY) 2007 and 2008 and the first 6 months of FY 2009 to CMS, CMS contractors, or Medicare providers.

As of October 8, 2010, CMS had not collected the majority of overpayment amounts identified in OIG audit reports. Of the 154 OIG audit reports with sustained overpayment amounts totaling $416.3 million, CMS reported collecting $84.2 million. Of the $84.2 million, CMS reported collecting the full sustained amounts totaling $83.3 million for 113 reports and partial amounts totaling $896,000 for 8 reports. However, for various reasons, CMS did not collect the remaining $332.1 million. CMS’s collections were limited because of time constraints imposed by the statute of limitations on overpayment collections. In addition, it did not provide its contractors with adequate guidance for collecting overpayments and did not have an effective system for monitoring its contractors’ collection efforts. Read More