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How CMS Could Prevent Home Health Deserts Caused by PDGM

Posted on Monday, February 24, 2020 12:22 PM

In 2016, CMS finalized a rule that required Medicare health care providers to return any overpayment in a six-year period.  If they don’t admit to the overpayment, the rule allows MACs to demand repayment for CMS. 

“Our general aim of this final rule is to strengthen program integrity and to ensure that the Medicare Trust Funds are protected and made whole and that taxpayer dollars are not wasted,” CMS officials said at the time. “There’s a scenario where Agency A buys Agency B, and Agency B’s claims are audited from four years ago with Medicare demanding $2 million back,” Wolfe said. “Because Agency A bought that other business, they could say, ‘Hey, look. You know, Medicare is saying we owe that money back. If that’s right, you need to be on the hook for paying.’ But it doesn’t work if you’ve got a defunct agency you’re dealing with.”

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