MEDICARE OVERPAYMENT PERIOD EXTENDED: A provision in the American Taxpayer Relief Act of 2012, the “fiscal cliff” legislation signed into law Jan. 2, extends the statute of limitations on Medicare overpayment recoveries from three years to five years. Section 638 of ATRA amends Section 1870 of the Social Security Act, which covers the acceptable time frame under which the Centers for Medicare and Medicaid Services can recover a Medicare overpayment. Before ATRA, a provider who received an overpayment was “to be deemed without fault” if the determination of an overpayment “was made subsequent to the third year following the year in which notice was sent to such individual that such amount had been paid,” according to the Social Security Act. Under Section 638 of ATRA, “third year” was replaced with “fifth year.” The provision went into effect Jan. 2. Experts say that the statute of limitations extension negatively affects providers, both in terms of increasing provider uncertainty and increasing costs associated with defending and appealing old claims. FRAUD PREVENTION APPEARS PROMISING: The Centers for Medicare and Medicaid Services’ Fraud Prevention System (FPS) helped stop, prevent, or identify roughly $115 million in fraudulent payments during its first year of operation, according […]
MEDICARE OVERPAYMENT PERIOD EXTENDED: A provision in the American Taxpayer Relief Act of 2012, the “fiscal cliff” legislation signed into law Jan. 2, extends the statute of limitations on Medicare overpayment recoveries from three years to five years. Section 638 of ATRA amends Section 1870 of the Social Security Act, which covers the acceptable time frame under which the Centers for Medicare and Medicaid Services can recover a Medicare overpayment. Before ATRA, a provider who received an overpayment was “to be deemed without fault” if the determination of an overpayment “was made subsequent to the third year following the year in which notice was sent to such individual that such amount had been paid,” according to the Social Security Act. Under Section 638 of ATRA, “third year” was replaced with “fifth year.” The provision went into effect Jan. 2. Experts say that the statute of limitations extension negatively affects providers, both in terms of increasing provider uncertainty and increasing costs associated with defending and appealing old claims.
FRAUD PREVENTION APPEARS PROMISING: The Centers for Medicare and Medicaid Services’ Fraud Prevention System (FPS) helped stop, prevent, or identify roughly $115 million in fraudulent payments during its first year of operation, according to a CMS report released Dec. 14, 2012. The congressionally mandated Report to Congress: Fraud Prevention System First Implementation Year—which was due Oct. 1, 2012, and was released nearly three months late—also said the FPS generated leads for 536 investigations conducted by CMS program integrity contractors, and it helped support 511 ongoing investigations. The FPS, which was launched July 1, 2011, uses predictive modeling and data analytics to review all Medicare fee-for-service claims for indications of fraud. Meanwhile, a report released Dec. 17, 2012, from the Department of Health and Human Services Office of Inspector General was critical of CMS’s methodology and conclusions. The OIG said CMS “did not fully comply with the requirements for reporting actual and projected improper payments recovered and avoided in the Medicare fee-for-service program and its return on investment related to its use of predictive analytics technologies.”
