MSP Recovery Audit Contractor Duties and Recovery Efforts

In 2012 CMS selected CGI Federal, Inc. as the Medicare Secondary Payer Recovery Audit Contractor, "MSP RAC".  (Interestingly, CGI Federal is the same contractor responsible for the rather unsuccessful rollout of HealthCare.gov.)   The MSP RAC's focus is on the recovery of MSP debts from group health plans.  The Government Accountability Office has described the role of the MSP RAC as follows: “CMS seeks the services of a Medicare Secondary Payer (MSP) Recovery Audit Contractor (RAC) to identify and recover overpayments stemming from instances where Medicare made payment under Medicare Parts A or B as the primary insurer, but a GHP had primary payment responsibility.”  The MSP RAC’s contract involves an optional task for the recovery of Non-GHP debts in situations where a Non-GHP RRE has ongoing responsibility for medicals.

There is no indication that the MSP RAC will have involvement in Section 111 or assessing reporting penalties.  The statute authorizing CMS's use of RACs, 42 U.S.C. § 1395ddd(h), provides for the use of RACs "for the purpose of identifying underpayments and overpayments and recouping overpayments under this subchapter with respect to all services for which payment is made under this subchapter."  The statute makes no mention of Section 111 reporting penalties and does not provide that CMS may use RACs to assess Section 111 reporting penalties.

If you have any questions regarding the MSP RAC or Section 111 reporting penalties, please let us know.  As we previously reported, CMS recently issued an Advance Notice of Proposed Rulemaking soliciting comments on the situations in which Section 111 reporting penalties may be imposed.  There is no indication that CMS is ready to begin assessing Section 111 reporting penalties at this time, as CMS has not yet issued rules specifying when reporting penalties may be imposed.