Medicare officials say they lack the authority to recoup overpayments to providers under the Medicare Advantage program. The Government Accountability Office disagrees.
In a recent report, GAO encourages Medicare officials to more closely monitor spending under the MA program, Medicare's alternative HMO plan.
The 52-page report, which grades the federal government's oversight of Medicare Advantage spending, says the Centers for Medicare & Medicaid Services has not complied with a law requiring an audit of one-third of all Medicare Advantage participating care contractors.
GAO said CMS did not meet its one-third audit requirement of the $51 billion Medicare Advantage program, which provides care for some 7 million of Medicare's 43 million beneficiaries.
"CMS is planning to conduct other financial reviews of organizations to meet the audit requirement for contract year 2006, but by the end of our fieldwork in June 2007, CMS had not finalized its plans," GAO reported.
According to the report, CMS's 2006 audit of 80 organizations found 18 were overpaid prior to providing services, with no exact amount given. In an audit of 2003, however, CMS overpaid contractors between $34 and $59 million. CMS believes it does not have the authority to recoup the overpayments.
In a July 19 letter, Leslie Norwalk, then acting administrator of CMS, said CMS is working to improve its oversight methods. Norwalk warned, however, that sanctions to companies that have been overpaid can adversely affect care to beneficiaries if a company participating in Medicare Advantage is forced to reduce benefits due to an audit.
GAO said CMS should get authority from Congress to chase down overpayments to prescription drug companies and healthcare companies participating in the program. To this, Norwalk said CMS agrees, as long as it is necessary and "preserves the competitive bidding process."