Review of Cahaba Government Benefit Administrators, LLC, Medicare Payments to Providers Terminated Between January 1, 2003, and January 31, 2007

摘要

Medicare contractors, such as FIs and MACs, must comply with Medicare laws, regulations, and guidance, including provisions for processing payments to terminated Medicare providers. Section 1866(b) of the Act provides for the termination of provider agreements, which set forth the terms and conditions for participation in the Medicare program. Sections 1814(a) and 1866 of the Act generally do not allow payment for services provided on or after an agreements termination date. The Medicare Financial Management Manual, Pub. No. 100-06, chapter 7, requires Medicare contractors to maintain internal controls to prevent erroneous payments; chapter 3 requires Medicare contractors to pursue recovery of overpayments, including those made to terminated Medicare providers. Cahaba Government Benefit Administrators, LLC (Cahaba), was an FI during our audit period (January 1, 2003, through January 31, 2007). CMS subsequently awarded a MAC contract to Cahaba for the administration of Medicare Part A and Part B claims. Our objective was to determine whether Cahaba recovered Medicare overpayments for services furnished on or after the effective termination dates of provider agreements.