WASHINGTON – A recent study released by the Government Accountability Office encourages the federal government to more closely watch spending under Medicare’s alternative HMO care plan, the Medicare Advantage program.
According to the GAO, some of the participating private care providers in the program have been overpaid, with no current plans to recover the money.
In a 52-page July report grading the government’s oversight of Medicare Advantage spending, the GAO said 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.
The GAO said CMS did not meet its one-third audit requirement of the $51 billion Medicare Advantage program, which provides care for 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,” the 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 million and $59 million.
The CMS says it lacks authority to recoup the money. The GAO disagrees.
In a July 19 letter, Leslie Norwalk, then acting administrator of the CMS, said the CMS is working to improve its oversight methods. She 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.
The GAO said the CMS should get authority from Congress to chase down overpayments to prescription drug companies and healthcare companies participating in the program. Norwalk said the CMS agrees, as long as it is necessary and “preserves the competitive bidding process.”