The Office of Inspector General (OIG) of the Department of Health and
Human Services advised in the 2013 OIG Work Plan that they would be reviewing
payments for Alien Beneficiaries Unlawfully present in the United States. The
OIG will determine whether Medicare payments were made on behalf of
beneficiaries who were unlawfully present in the United States on the dates of
services. Medicare payment may not be made for items and services furnished to
alien beneficiaries who were not lawfully present in the United States. (The
Centers for Medicare & Medicaid Services (CMS) Internet-Only Manual,
Medicare Claims Processing Manual (100-04), Chapter 1, § 10.1.4.8.) Medicare
prohibits payment for services rendered to individuals who are not
"qualified aliens." (Personal Responsibility and Work Opportunity
Reconciliation Act of 1996, § 401.)
These audits that have been conducted by the OIG have resulted in
overpayments to providers across the country, including the National Government
Services states of business being identified. As a result of these audit
findings, the OIG and the CMS have charged National Government Services to
begin the process of recouping those overpayments. The first tier of this
process has now begun and we have generated the first round of those
overpayment adjustments. As with any overpayment situation letters have also
been generated. These letters will begin to be mailed on Monday, December 10.
The listing of the claims impacted by this action that you will receive with
your letter will indicate that; "This claim adjustment was due to a mass
adjustment." The detailed description of the adjustment can be found on
Fiscal Intermediary Standard System. The letters will contain the guidelines
for applying for an extended repayment plan so that you may research that
option if necessary.
If you receive one of these overpayment letters it will be of major
importance for your facility/office to review it and plan appropriately. All
normal overpayment options apply and will be described completely in the
letter. It will be important for you to be aware so that your facility/office
can stay on top of the overpayment situation and work with National Government
Services to control how your overpayment is repaid.
From National Government Services: http://view.email.ngsmedicare.com/?j=ff051670766607&m=fe98137075650c7976&ls=fe6a16757565037c7616&l=ff2c1579756d&s=fe8d1277776c057474&jb=ffcf14&ju=fec11776776d007b&r=0
