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Incarcerated Beneficiary Recoveries From Providers

In June and July 2013, the Centers for Medicare & Medicaid Services (CMS) initiated recoveries from providers and suppliers based on data that indicated a beneficiary was incarcerated on the date of service. Medicare identified previously paid claims that contained a date of service partially or fully overlapping a period when a beneficiary was apparently incarcerated based on information CMS receives from the Social Security Administration (SSA). As a result, a large number of overpayments were identified and overpayment (demand) letters sent. CMS has since learned that the information related to these periods of incarceration was, in some cases, incomplete for CMS purposes.

CMA and many other state societies have sent a joint letter from the American Medical Association (AMA) asking CMS to halt their recovery efforts until the data has been corrected. In a recent call, CMS indicated they are actively addressing the problem, and are working on restoring the original data on the Medicare Enrollment Data Base. They will identify all of the claims that resulted in overpayment requests being generated, and make changes to the claims processing system to identify the claims that were denied in error. Reprocessing will be completed by the Medicare Administrative Contractors. They don’t anticipate this process will be completed prior to October at the earliest.

CMA will continue to provide you with updates and post the news on its website as it becomes available.

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