CMS has announced it will require next to nothing from insurers for any excess payments they received from 2011 to 2017.
Kaiser Health News
While the decision could cost Medicare plans billions of dollars in the future, it will take years before any penalty comes due. And health plans will be allowed to pocket hundreds of millions of dollars in overcharges and possibly much more for audits before 2018. Exactly how much is not clear because audits as far back as 2011 have yet to be completed.
In 2018, CMS said it pays $54 million annually to conduct 30 of the audits. Without extrapolation for years 2011-17, CMS won’t come near to recouping that much. David Lipschutz, an attorney with the Center for Medicare Advocacy, said he was still evaluating the rule, though he added it was unclear whether the agency is using its entire authority.
In all, 71 of the 90 audits uncovered net overpayments, which topped $1,000 per patient, on average, in 23 audits. CMS paid the remaining plans too little on average, anywhere from $8 to $773 per patient, the records showed.
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