Sunday, May 19, 2024

AUDIT: Reckless Medicare Screws Taxpayers Yet Again

If D.C. bureaucrats had done a better job safeguarding the taxpayers’ hard-earned money, then Medicare, over five years, could have saved up to $128 million.

This is according to an audit that the U.S. Department of Health and Human Services’ (HHS) Office of Inspector General (OIG) published late last month.

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The audit covered January 1, 2017, through December 31, 2021.

“The number of veterans who received Veterans Health Administration (VHA)-authorized community care services generally increased. Duplicate Medicare payments for individuals who had both Medicare and VHA benefits also increased. These duplicate payments occurred because the Centers for Medicare and Medicaid Services (CMS) did not implement controls to address duplicate payments for services provided to dually eligible enrollees,” according to the audit.

“If CMS had developed an interagency process to include VHA enrollment, claims, and payment data in CMS’s data repository and had established an internal process (such as system edits) to address duplicate payments, Medicare could have saved up to $128 million in payments for claims for medical services that VHA authorized and paid for during our audit period.”

Auditors said Medicare’s and VHA’s duplicate payments are a longstanding issue, dating back to 1979.

The OIG audit covered $19.2 billion in Medicare Parts A and B payments for 36.3 million claims for individuals eligible for these and VHA benefits. They received services from VA’s community providers during the audit period.

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The $19.2 billion was associated with all claims related to these individuals, irrespective of whether VHA authorized and paid for the claims.

The VHA of the Department of Veterans Affairs (VA) provides medical services at approximately 1,300 medical facilities and serves 9 million veterans each year.

CMS administers Medicare. CMS contracts with Medicare Administrative Contractors (MACs) to process and pay claims submitted for services, conduct reviews and audits, safeguard against fraud and abuse, and educate providers on Medicare billing requirements.

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