CMS may seek $225 million in uncollected Medicaid overpayments

The Centers for Medicare & Medicaid Services should press states to repay about $225 million in Medicaid overpayments accrued over a 10-year period, according to a recent report from the Department of Health and Human Services Office of Inspector General (OIG).

As of December, CMS had recovered $987 million out of $1.2 billion in Medicaid overpayments verified during fiscal years 2000-2009, according to the OIG report released Feb. 20. The OIG audit review focused on 11 states with a “high dollar amount of sustained overpayments”: Florida, Indiana, Illinois, Kansas, Louisiana, Massachusetts, Missouri, New York, New Jersey, Oregon and Pennsylvania.

The OIG recommends that CMS collect the outstanding overpayments. CMS concurs in part with that recommendation, according to a response letter from Acting Administrator Marilyn Tavenner. However, CMS will review additional information provided by the states in question before making a final determination, Tavenner wrote.

In May, CMS adjusted regulations governing Medicaid overpayments made to long-term care operators and other healthcare providers. A proposed rule gave states 60 days to return overpayments resulting from fraud to the federal government, although providers said this would place an undue burden on them. CMS extended the repayment window to one year.