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Rebecca Farley

Director, Policy & Advocacy, National Council for Behavioral Health

CMS Addresses Overpayments for Services Provided to Incarcerated Beneficiaries

August 27, 2013 | Uncategorized | Comments
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The Centers for Medicare and Medicaid Services has released a document providing an update on Medicare demand letters and Medicare claim cancellations associated with an item or service provided to incarcerated beneficiaries.

Medicare will generally not pay for medical items and services furnished to a beneficiary who was incarcerated when the items and services were furnished. A beneficiary may be considered “incarcerated” even when the individual is not confined within a penal facility, such as a beneficiary who is on a supervised release, on medical furlough, residing in a halfway house, or other similar situation.

The new CMS document notes that Medicare had previously identified paid claims that overlapped with a period of the beneficiary’s incarceration and had begun the process to recoup overpayments. However, it has recently come to light that the data identifying these periods of incarceration may not have been complete for CMS purposes. Therefore, CMS is reviewing the data to identify and correct any cases where payments were inappropriately classified as overpayments.