Home Health & Hospice Week

Report urges NGS to collect more in lookback-year overpayments.

You might see tighter cap overpayment procedures if a federal watchdog agency gets its way.

In a new report, the HHS Office of Inspector General examines whether HHH Medicare Administrative Contractor National Government Services accurately calculated and collected hospice cap overpayments in 2019 and three prior “lookback” cap years.

The MAC did well on calculating the overpayments, the OIG judges. “NGS accurately calculated all cap amounts,” with “$213.4 million in total cap overpayments,” according to the report.

But it fell down on the collection piece, the OIG claims. “NGS did not attempt to collect … $2.1 million in net lookback overpayments because of its internal policy of not pursuing lookback cap calculation amounts that were less than a set threshold,” the report says. It did collect $211.3 million in cap overpayments, in comparison.

Plus: In contradiction of Centers for Medicare & Medicaid Services instructions, NGS didn’t require hospices to remit their cap overpayments when submitting their cap overpayment determinations. Instead, “NGS instructed hospices to wait to submit the overpayments … until the hospice received a demand letter from NGS, which took an average of more than two months,” the OIG criticizes. “Because of NGS’s instructions, the Federal Government lost the benefit of having the overpayment funds for its use for an additional average of more than two months.” In 2019, those funds totaled about $6.1 million, the OIG says.

In a response letter to the report, NGS says it already has changed its instructions to hospices to submit their repayments along with their cap determination notices.

However, the MAC pushes back on the recommendations to discontinue its policy of not collecting lookback years under a certain threshold. “NGS policy conforms to CMS requirements,” NGS Jurisdiction K Program Manager Thomas Hansen contends in the response letter.

“After reviewing NGS’s comments, we maintain that our findings and recommendations are valid,” the OIG counters.

Stay tuned to see who wins this battle. When the OIG issued a report on this topic last year regarding HHH MAC Palmetto GBA and the 2017 cap year, Palmetto agreed to change its internal policies (see HHHW, Vol. 30, No. 29).

Note: See the report at https://oig.hhs.gov/oas/reports/region6/62108004.pdf.