CMS Overpayment Abuse: Where’s the Accountability?

A recent Becker’s article claims that the OIG found that UHC and Humana combined collected more than $177M in overpayments from CMS.

What is most astonishing to me is that CMS has yet to decide whether to “pursue” overpayment. So while physicians and all health care providers continue to be targeted by CMS agencies and nickled-and-dimed to death, these huge conglomerates and their sacred employees get away scot free?

As a taxpayer and Medicare beneficiary who has to worry whether or not Medicare will continue to be there for me as I age, I am incensed. As a retired health care provider, I want my pound of flesh with some retribution. The employee who concocted these schemes should be arrested, prosecuted, put in jail and forced to pay significant civil penalties. Those include a lifetime ban on working for or with financial or insurance companies. 

As for the companies themselves, the amount they collected seems to violate the False Claims Act and seem to justify banishment from Medicare contracting for a significant period of time. The current penalties, financially and otherwise, to the corporations and their employees are but  a blip on the radar and do nothing to deter this continued abuse. They are not even a parking ticket to these billion-dollar monsters.

The ROI for going after DPMs and other physicians may be 9:1, but going after UHC, Humana and others has got to be even higher. And having the OIG cracking down on UHC and Humana will no doubt have a chilling effect on other MCR Part C plans who choose to go down this path.

—Paul Kesselman, DPM