RISE summarizes recent regulatory-related news.

OIG to CMS: Recover $226M in uncollected Medicare overpayments

A new Office of Inspector General (OIG) report reveals that the Centers for Medicare & Medicaid Services (CMS) has collected only half of the $498 million in Medicare overpayments that the watchdog has identified in previous audits.

The OIG reviewed 148 Medicare audit reports issued during the 27-month period from October 1, 2014, through December 31, 2016. Although CMS agreed to collect the recommended overpayments of nearly $500 million, the agency reported it collected only $272 million or 55 percent of the overpayments. However, CMS was only able to provide documentation that it collected $120 million of the $272 million.

The watchdog also reports that CMS did not take corrective action in response to all the recommendations it made 10 years ago in the audit report, Obstacles to Collection of Millions in Medicare Overpayments.

In the latest report, OIG recommends that CMS continue efforts to recover the $226 million in uncollected payments. In addition, it asked CMS to determine what portion of the $152 million was collected and recorded in its accounting system. CMS has agreed to the recommendations.

CMS turns to public to help improve Medicare Advantage

The Centers for Medicare & Medicaid Services (CMS) wants input from the public to help achieve its vision that all people with Medicare receive more equitable care.

CMS has released a Request for information seeking public comment on the Medicare Advantage program. The agency wants input on ways it can achieve its vision for all parts of Medicare to work towards a future where Medicare beneficiaries receive more equitable, high quality, and person-centered care that is affordable and sustainable.

“Medicare Advantage is a critical part of CMS’ vision to advance health equity expand access to affordable coverage and care; drive high-quality, person-centered care; and promote affordability and sustainability of Medicare, “ CMS Administrator Chiquita Brooks-LaSure said in an announcement. “Medicare Advantage plans are essential partners in this work.”

Dr. Meena Seshamani, CMS deputy administrator and director of the Center for Medicare, said the agency sees an opportunity to partner with as many stakeholders as possible to better understand how care innovations are changing outcomes and costs, and how Medicare Advantage is working for enrollees.

CMS has prioritized increased engagement with the agency’s partners and the communities it serves throughout the policy development and implementation process. It said it is committed to creating additional opportunities to engage the public and drive innovation in ways that best serve people with Medicare. Feedback from plans, providers, beneficiary advocates, states, employers and unions, and other partners will help inform the Medicare Advantage policy development and implementation process.

HHS invests $8.5M to fund programs aimed to reduce pregnancy-related deaths and complications

The HHS Office of the Assistant Secretary for Health (OASH) announced it will invest $8.5 million in initiatives designed to reduce pregnancy-related deaths and complications that impact minority populations and those living in rural areas. The United States' maternal mortality rate is the highest of any developed nation in the world and more than double the rate of peer countries. But a deeper dive finds American Indian/Alaska Native (AI/AN) and Black women are two to three times more likely to die from a pregnancy-related cause than white women. In addition, more than one-half of pregnancy-related mortality occurs in the 12-month postpartum period and about one-third occurs between seven and 365 days post-delivery. In the funding announcement, OASH recognized the winners of its racial equity in postpartum care challenge among organizations that successfully increased access to and quality of care for postpartum visits for Black and AI/AN women enrolled in Medicare or the Children’s Health Insurance Program. It also announced applications for new funding opportunities for maternal health. "Maternal health is a top priority for my office," Assistant Secretary for Health Admiral Rachel Levine said in the announcement. "New efforts by this administration, coupled with an array of existing resources already available, will ensure maternal health excellence for this country is achieved."