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Policy about Medicare payments for incarcerated patients under review

Due to strong concerns from the American Medical Association (AMA), Wisconsin Medical Society and other state associations, the Centers for Medicare & Medicaid Services (CMS) is reviewing its policy regarding services provided to Medicare patients who were incarcerated when the services were provided. Through its Medicare Administrative Contractors, CMS recently initiated recoveries from physicians and other health care professionals for these services.

Earlier today, CMS posted on its website answers to frequently asked questions about this issue. The information clarifies what actions physicians should take at this time as well as a timeline for resolution to this issue. CMS will post updates on its All-Fee-For-Service-Providers page on its website.

CMS also is asking physicians and other Medicare providers to no longer encourage beneficiaries to contact their local Social Security office about having their records updated as a result of this recent issue. Physicians and other Medicare providers also are asked to no longer fax information to CMS Regional Offices while CMS is working to develop processes for resolving this issue.

Medicare generally will not pay for medical services or items for a beneficiary who was incarcerated when the services or items were furnished, according to a revised directive. “A beneficiary may be ‘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,” according to the directive.

In response to a January 2013 report from the Office of Inspector General, Medicare identified previously paid claims with dates of service overlapping a period “when the beneficiary was apparently incarcerated based on information CMS receives from the Social Security Administration. CMS has since learned that the information related to these periods of incarcerations was, in some cases, incomplete for CMS purposes.”

CMS is reviewing these data and working to improve the process used to identify periods of incarceration. It also will be correcting any inappropriate overpayment recoveries.

Back to August 1, 2013 Medigram