Office of Inspector General Issues Semi-Annual Report to Congress
Jesse Hamby
November 30, 2012

The Report contains several references to the Medicare Secondary Payer Act, including the following:

 

Page 72 — OIG Recommendation:  Medicare Secondary Payer. Ensure sufficient resources and contractor training for retroactively examining paid claims to identify other payer sources and initiating recovery action on all related  over-payments. The recommendation related to findings in the following OIG reports: A-02-98-01036, A-04-92-02057, A-09-89-00162, A-10-86-62005.

Implementing Action:  Section 301 of the MMA clarifies the Secretary’s authority to make certain reimbursable conditional payments and to take recovery actions against all responsible entities, including collection of damages, under Medicare Secondary Payer provisions. This section builds on other program improvements implemented by the Balanced Budget Act of 1997 (BBA), Omnibus Budget Reconciliation Act (OBRA) 1993, OBRA 1990, and  OBRA 1989. CBO estimated savings of $1.2 billion for FY 2012.

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Page 74 — Medicare Secondary Payer.  A-02-98-01036 Implement stronger follow-up procedures for employers who fail to respond to data requests, exercise civil monetary penalty (CMP) authority, and seek necessary legislative authority for mandatory data reporting. The recommendations related to findings in the following OIG reports: A-02-02-01037, A-02-02-01038, A-04-01-07002, A-09-89-00100.

Section 111 of the Medicare, Medicaid, and SCHIP Extension Act of 2007 amended the Medicare secondary payer provisions of the Social Security Act, § 1862(b), to provide for mandatory reporting for various categories. CBO estimated savings of $100 million for FY 2012.  Estimated Savings (FY 2012) $100 million.

Franco Signor Commentary:

This further update supplements our recent blog wherein we cite to the OIG Work Plan for Fiscal Year 2013.  This Report is further evidence that the Government is stepping up its efforts to enforce Medicare Secondary Payer compliance.  The fact that the Government is seeking to utilize reporting data to conduct retroactive review of conditional payments is alive and well.  Involve Franco Signor LLC in your claims involving Medicare beneficiaries!

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