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Audit (A-05-09-00035)

04-20-2010
Review of National Government Services, Inc., Medicare Payments to Providers Terminated Between January 1, 2003, and January 31, 2007

Executive Summary

National Government Services, Inc. (NGS), did not always recover Medicare overpayments for services furnished on or after the effective termination dates of provider agreements or during termination-related Denial of Payment for New Admissions (DPNA) sanction periods. CMS may impose DPNA sanctions on skilled nursing facilities that fail to comply with Medicare requirements. Payments for services provided on or after a provider agreementís termination date or for services provided to beneficiaries initially admitted during a DPNA sanction period are generally not allowable.

For 5 of the 64 terminated providers whose payments we reviewed, NGS had not recovered a total of $1.2 million in overpayments that were subject to recovery. NGS had not recovered $1.16 million of this total because it did not follow its procedures to retroactively identify payments for posttermination services. NGS had not recovered the remaining $62,000 because it had not yet implemented written DPNA-related procedures. NGS confirmed that the overpayments were subject to recovery.

We recommended that NGS recover $1.2 million in overpayments to the five terminated providers and follow its procedures to retroactively identify and recover overpayments for services furnished on or after the providersí effective termination dates. NGS agreed with our recommendations and said that it was recovering the overpayments.

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