CMS Fails Audit and is Told to “Get More Money!”

Three quick stories, each of Medicare money that has vanished, never to be found.

First, a report from the U.S. Department of Health and Human Services Office of Inspector General (HHS OIG) states that the Centers for Medicare & Medicaid Services (CMS) has not done enough to recoup improper Medicare payments found at 12 hospitals. Nothing like a report saying “CMS isn’t getting enough money” to prompt more audits. According to the OIG report, CMS is short-staffed, like almost every other employer in America.

Apparently, CMS claims to have not enough workers to track down every dollar, which I must say, makes me superstitious. If CMS is claiming to not have enough resources to track down money that has been targeted at 12 hospitals, how is it conducting the other audits nationwide?

Among these 12 hospitals, supposedly, there is $82 million allegedly owed to CMS.

OIG recommended recouping all the money, but added that CMS has provided insufficient information. Specifically, CMS did not provide information on the status of appeals hospitals levied against OIG’s overpayment findings. CMS didn’t provide information on the reason for the appeal or status of the action. Personally, I am just happy the hospitals appealed.

The second story involves CMS’s continual audits of providers, especially the Medicare Advantage (MA) plans, which are nightmares. CMS has agreed to release the results of audits of 90 MA plans conducted between 2011 and 2013. These records are expected to demonstrate more than $600 million in MA overpayments due to alleged upcoding.

Finally, a North Carolina hospital system, Atrium Health, publicly announced that in 2019, it provided $640 million to Medicare patients that was never recouped. You would think this chilling – unless you knew the tax breaks associated with the related charity.

But for the same year that Atrium’s website says it recorded the $640 million loss on Medicare, the hospital system claimed $82 million in profits from Medicare – and an additional $37.2 million in profits from MA, according to a federally required financial document.

Sleight of hand and hocus pocus.

Programming note: Listen to healthcare attorney Knicole Emanuel’s RAC Report every Monday on Monitor Mondays, 10 Eastern.