- The Centers for Medicare & Medicaid Services (CMS) is missing out on opportunities to help identify Medicare fraud and abuse because a significant number of Medicare Summary Notices (MSNs) never find their way to beneficiaries through the mail, according to a report published by the Office of Inspector General (OIG).
In a review of claims processors in 2012, the division with the Department of Health & Human Services (HHS) found that as many as 4.2 million MSNs were reported as undeliverable to beneficiaries. These findings, therefore, reveal that CMS is deprived of one of its most important fraud detection tools — patients.
“CMS recommends that beneficiaries check their MSNs carefully for suspicious charges, as services or items appearing on an MSN that were never provided may be a sign of fraudulent activity,” the report states. Obviously, Medicare beneficiaries cannot do this without having their claims in hand.
While the 4.2 million undeliverable MSNs are but a small percentage of the 194 million total MSNs sent during that time, the amounts within them can easily add up. A sample of 1,445 MSNs returned in January 2013 added up to $2.7 million in claims with their undeliverable status resulting from a mixture of compromised provider and beneficiary numbers.
According to the report, a principle cause of undelivered MSNs is a lack of procedures for tracking and following up on them:
CMS requires claims processors to provide MSNs to Medicare beneficiaries, but it has not issued guidance regarding whether or how to track and follow up on undelivered MSNs. In practice, not all claims processors track or follow up on undelivered MSNs, and those that do utilize a variety of methods. According to CMS staff, when claims processors have requested guidance on the storage of undelivered MSNs, CMS has allowed claims processors to destroy the undelivered MSNs. However, CMS has not issued a written directive to all claims processors on the storage and/or destruction of undelivered MSNs.
OIG has recommended two steps CMS should take to reduce the number of undelivered MSNs, both of the which the latter has agreed with. “Without guidance for handling undelivered MSNs, claims processors have developed their own approaches. However, these approaches are not consistent across the Medicare program because not all claims processors track or follow up on undelivered MSNs and those that do use a variety of methods,” the OIG maintains.
The first focuses on issuing guidance to claims processes, particularly instructions about storing or destroying these MSNs and maintaining accurate information about their status. The second deals with giving claims processors improved access to complete beneficiary information and ensuring that appropriate address formats are in place.
Read the full report here.