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Update on Medicare and Incarcerated Patients

Medicare has been investigating and recovering payments for prior claims regarding patients who were incarcerated at time of service.

In a update dated July 23, 2013, Palmetto GBA reported:

“Medicare identified previously paid claims that contain a date of service partially or fully overlapping a period when a beneficiary was apparently incarcerated… As a result, a large number of overpayments were identified, demand letters released, and, in many cases, automatic recoupment of overpayments made.”

Regarding Medicare’s policy on the subject of incarcerated patients, Palmetto reminds us that:

“Medicare will generally not pay for medical items and services furnished to a beneficiary who was incarcerated when the items and services were furnished.”

CMS states that it:

“…is actively reviewing these data and will be taking action to improve the process used to identify periods of incarceration. As part of this effort, CMS is working to quickly… correct any inappropriate overpayment recoveries.”

CMS will continue to issue messages about this topic to keep the provider and supplier community informed. Information will also be posted on the All-Fee-For-Service-Providers page on the CMS website.

To read the full update, click here.

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