OIG: Medicare overpayments for nursing home services could reach $130 million

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The Medicare program might have paid nearly $130 million too much for hospital and laboratory services from 2001 to 2003, a federal investigation has discovered.

The amount constitutes unintended double payments for services, according to auditors with the Department of Health and Human Services.
HHS's Office of Inspector General examined outlays for outpatient hospital, lab and radiology services included in Medicare Part A payments made to skilled nursing facilities, hoping to learn whether those services also had been paid for by the Part B program.

Auditors found that Medicare Part B potentially overpaid more than $107 million for such services in 2001 and 2002. In addition, even after certain corrective measures were put in place, potential overpayments were still about $23 million in 2003, the OIG said.

As a result of its findings, OIG recommended that the Centers for Medicare & Medicaid Services instruct payment contractors to re-examine records for the possibility of overpayments and then move to recover them where appropriate. It also suggested CMS test and refine payment system protocols designed to identify such overpayments.
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The full audit report is available at http://www.oig.hhs.gov/oas/reports/region1/10600503.pdf.