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CMS’ recovery audit contractor update details millions in payment corrections

WASHINGTON – The Centers for Medicare & Medicaid Services has corrected $684.8 million in improper payments since FY 2010, according to an update released earlier this month on its Medicare Fee-for-Service Recovery Audit Program.

The recovery audit contractor update from CMS details corrected overpayments and underpayments from FY 2010 through June of this year and shows a significant jump in overpayments collected in FY 2011.

Between October 2009 and September 2010, $75.4 million in overpayments were collected while $233.4 million alone was collected between March and June of this year. In the second quarter of FY 2011, $185.2 million in overpayments were collected. All together, $575.2 million in overpayments have been collected since FY 2010.

The difference between underpayments returned in FY 2010 and the third quarter of 2011 is not as dramatic. In FY 2010, $16.9 million in overpayments were returned while in the third quarter of FY 2011, $55.9 million were returned. The total returned since FY 2010 is $109.6 million.

The update also noted the top overpayment issues for each recovery auditor:

  • For Diversified Collection Services in Region A: renal and urinary tract disorders.
  • For CGI, Inc. in Region B: extensive operating room procedures unrelated to principal diagnosis.
  • For Connolly, Inc. in Region C: durable medical equipment, prosthetics, orthotics and supplies provided during an inpatient stay.
  • For HealthDataInsights in Region D: minor surgery and other inpatient treatments.

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