CMS, OIG Disconnect Highlighted In Medicare Overpayments Report

Federal watchdogs reported the Centers for Medicare & Medicaid Services (CMS) has not collected the near-$500 million in Medicare overpayments that were found in audits over a two-year period beginning in 2014.

The Office of the Inspector General at the Department of Health and Human Services (OIG-HHS) recently reviewed 148 Medicare audits it conducted for 30 months between 2014 and 2016 and could only verify that CMS collected $120 million of the $498 million in overpayments.

CMS, on the other hand, said it collected a total of $272 million – 55% – but OIG could not confirm CMS collected the remaining $152 million because CMS “did not provide adequate documentation to support” that it collected the rest, according to OIG.


Furthering the disconnect between the two agencies, CMS only implemented one of nine recommendations made by OIG following the latest audit and report.

OIG had recommended — among other things — that CMS continue its efforts to recover the rest of the $226 million in overpayments, determine which portion of the $152 million was collected and recorded in its accounting system and develop a plan to resolve cost report issues that the OIG found.

CMS only agreed to the first recommendation.


“CMS generally did not concur with our findings or recommendations,” the OIG wrote in a statement. “Of our nine recommendations, CMS concurred with one recommendation, did not concur with seven recommendations, and did not explicitly state that it concurred or did not concur with one recommendation.”

OIG also noted that CMS did not take corrective action in response to recommendations made following a similar audit back in 2009.

In that audit, OIG reported CMS had not recovered $332 million of the $416 million in Medicare overpayments in an identical 30-month period that ended in March 2009.

For now, OIG will update its records to show that CMS collected $272 million, but is requesting detailed documentation for the full amount.

“After reviewing CMS’ comments, we maintain that our findings and recommendations are valid,” the OIG wrote.

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