Providers Overpaid: Medicare's Multimillion-dollar Mistake

The Centers for Medicare and Medcaid Services told Georgia Health News last Wednesday that the agency is seeking to recoup nearly $55 million from hospitals and other medical providers in Georgia and other surrounding states, citing contractor errors. The agency found nearly 268,000 claims from hospitals, rural health clinics, and other providers that mistakenly paid though the traditional fee-for-service Medicare program. The agency also sated that "the patients served in these instances were members of a Medicare Advantage program and they were run by private insurers, and that hospitals should have been paid by those health plans instead". 

The states affected are Georgia (owes $19.1 million), Tennessee ($15.4 million) and Alabama ($11.9 million), and another $8.3 million from other states. 


Among rural providers, Upson Regional Medical Center in Thomaston, GA owes the feds $254,000. The recoupment involves more than 1,400 claims from May 2014 to May 2018. The hospital executive, Sallie Barker, stated "Hospitals are being Penalized for someone else's mistake" and that she had asked questions but wasn't getting any answers. HomeTown Health, an association of rural hosptials in Georgia says their repayments from its members could range from $3,000 to $254,000.

For hospitals struggling with cash flow, a takeback can create a big problem. When you’re given a mandate, you’ve got to figure out how to pay it.
— Jimmy Lewis, CEO, HomeTown Health

The medical providers had until a tight deadline of July 1st for repayment but CMS announced that it extended the planned repayment by two weeks to "allow providers time to research the issue and provide documentaion showing they do not owe the funds". 

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