OIG: Investigations Recovered $26B in FY2010
"Federal and local investigators found that MEBH employees did not provide any services to the at-risk child with cerebral palsy, even though she was under their care. The child suffered severe bed sores and extreme weight loss as she slowly starved to death," the OIG report said.
"The company's employees "then attempted to conceal the incident by destroying old records and creating new false records of the child's care."
• Medicare's Program Safeguard Contractors, which identify and refer Medicare overpayments to claims processors for collection, did not result in significant recoveries. In fact, "only 7% ($55 million of $835 million) had been collected by claims processors as of June, 2008," although 4,239 overpayments had been referred.
• $34 million was overpaid to inpatient rehabilitation facilities for claims "that were improperly coded as discharges to home rather than transfers to other facilities." Medicare pays more when facilities discharge patients directly to home than for a transfer. The OIG found that even though the Centers for Medicare and Medicaid Services detected the miscoded claims, "fiscal intermediaries did not adjust the claims to prevent overpayments."
• As a result of a different investigation, the OIG found that some of these inpatient rehabilitation facilities were overpaid $20.2 million for claims with late patient assessment instruments.
Under Medicare Part D, the office found two expensive problems.
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- Providers Prep for New Payment Models as Population Health Grows
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- Aligning Executive Compensation with Provider Mission