Tuesday, June 18, 2013

CMS's MSP web site overhaul

CMS has rolled out its newly redesigned web pages. The new addresses are:

The What's new page, after three months, is nearly worthless. Many things have happened since June 2013, and almost none of them are listed on that page. 

Saturday, June 15, 2013

Congressional intent and Medicare Advantage

One additional item of evidence that undercuts the claims of Medicare Advantage plans that they stand in the same position as CMS under ordinary Medicare: The new section 1128J(d) of the Social Security Act, as added by section 6402 of the Affordable Care Act, is entitled “Reporting and Returning of Overpayments.” (42 USC 1320a-7k(d)) It lists Medicare Advantage plans as one of the "persons" to whom the new overpayment reporting requirements apply.

When Medicare has paid an item that it should not have paid, this is regarded as an "overpayment." If a "person" learns of an overpayment, that new provision requires that that person report the overpayment and return the funds to CMS, and to notify CMS of the reason for the overpayment. Failure to refund the money after 60 days is regarded as a violation of the False Claims Act.

This new rule includes as "persons" who are required to comply providers, suppliers, and Medicare Advantage plans. There would be no reason for Congress to include MA plans in this list if they were regarded as "standing in the shoes of the Medicare program." The fact that they are listed in this new section underscores the Congressional intent that MA plans be treated differently from CMS.