Here’s Why Your Tax Dollars Are Overpaying for Medicaid

January 3, 2019 | Rivkin Rounds Staff | Legislation and Public Policy | Medicare and Medicaid

A January 2 article in Bloomberg Law’s Health Law & Business, “Here’s Why Your Tax Dollars Are Overpaying for Medicaid,” discussed the Medicaid program’s difficulty in recovering inappropriate payments made by states to doctors. A December 11 report by the U.S. Department of Health and Human Services’ Office of Inspector General (OIG) said the lack of collections “illustrates a significant financial stewardship vulnerability” at the Centers for Medicare & Medicaid Services (CMS), which administers Medicaid jointly with the states.

The process for recovering overpayments is cumbersome, requiring CMS to identify an overpayment and then persuade the relevant state’s Medicaid agency that the overpayment finding is correct. States may appeal CMS’s findings using a backlogged appeal process, and close to $2 billion in overpayments up to eight years old have yet to be recovered.

The OIG urged CMS to develop procedures to speed up the recovery process. In the Bloomberg Law article, Rivkin Radler’s Eric Fader pointed out that the failure to collect the overpayments may be due in part to a lack of resources at CMS dedicated to working with the states on this issue.

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