CMS and OMIG Team Up To Measure Improper Payments

The Centers for Medicare & Medicaid Services (CMS) and the New York State Office of the Mediciad Inspector General (OMIG) have teamed up to analyze and measure whether improper payments in the Medicaid and State Child Health Insurance programs have been made to healthcare providers.  Under the Payment Error Rate Measurement (PERM) program, which was developed to comply with the Improper Payments Information Act (IPIA; Public Law 107-300) of 2002,  each federal agency is required to annually identify programs that may be susceptible to significant and improper payments, estimate the amount of improper payments, submit the estimated amounts to Congress and also submit a report on actions the agency is taking to reduce the improper payments.

CMS, its contractor (A+ Government Solutions, Inc.) and OMIG have the authority to collect information and, according to Medicaid Updates, such information can be “provided without patient consent.”

According to Medicaid Updates, documentation for federal fiscal year (Oct. 1, 201-Sept. 30, 2011) will be randomly selected and requested by A+ Government Solutions, Inc., and a provider will be required to timely respond to the request by providing the information to the CMS contractor with a copy to OMIG.

The OMIG’s role in the process is to a) assist A+ Government Solutions, Inc, in obtaining accurate and complete medical documentation; b) to review the medical documentation that supports the claim payment for accuracy and completeness; c) to appeal findings in the Dispute Resolution Process with the review contractor; d) to appeal findings upheld in the Dispute Resolution Process with CMS; and e) to collect any overpayments.

Healthcare providers should note that according to the government, failure to provide the requested records will result in a determination of erroneous payment and OMIG will pursue recovery.

Requests for documents from healthcare providers will begin August 2011.

To speak with a lawyer regarding health care issues, or to consult a lawyer regarding laws and legal issues concerning healthcare practice, please contact Deniza Gertsberg today.

UPDATE: Medicaid Update July 2011 includes a notification which changes the  previous start date for document requests from August to July 2011.