CMS should pursue all overpayments regardless of the amount.
Too often CMS upper mgmt says that 1 million or 5 million dollar overpayments are too small to pursue. If CMS would make an effort to recover all overpayments, perhaps providers would be more cautious in submitting claims.
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CMS agrees that all overpayments must be pursued. CMS collects all overpayments that have been calculated, that are greater than $100.
The commenter may have been referring to the development of cases that are believed to be small dollar value prior to the calculation of the overpayment. Resource constraints have historically been the driver of that approach. CMS, its contractors and law enforcement have prioritized their case load to go after high dollar value cases or instances where patient safety may be compromised.
CPI believes the new approaches to fraud detection being implemented through predictive analytics, as well as streamlining existing processes, will permit us to be able to take more actions in a shorter amount of time with the same amount of resources.
