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CMS seeks to stop illegal billing of Medicare enrollees

The CMS is looking to get the word out to providers that there are some Medicare beneficiaries who should not be charged cost-sharing.

The agency has grown concerned in recent months over reports that some people dually eligible for Medicare and Medicaid are being hit with coinsurance costs by providers despite them being in a savings program known as Qualified Medicare Beneficiary.

Under that program, which was enacted in 1988, Medicaid pays the premium deductibles and coinsurance for dual-eligibles. The CMS estimates that more than 7 million people are in the QMB program.

Tim Engelhardt, director for the CMS' Medicare-Medicaid coordination office, said at a conference on dual-eligibles this fall that these patients end up with debt collection for medical bills they weren't supposed to pay. In other cases, duals know they shouldn't be paying anything out of pocket but do so anyway over fears they'll lose access to that provider, Engelhardt said.

The agency has not shared how many people have been inappropriately charged.

The CMS and patient advocates found that some providers aren't aware that QMB enrollees should not be charged. Therefore, the agency has begun to informing them of new tools the CMS created to avoid such erroneous billing.

Starting this month, providers can access a web resource to verify QMB status for Medicare patients prior to billing for items and services.

For their part, providers are unsure how widespread this billing practice is and if additional guidance was needed.

"I think this is already pretty well understood by physician practices and don't think they are routinely imposing cost sharing," said Anders Gilberg, senior vice president of government affairs at MGMA.

A spokeswoman for AMGA declined to comment on the matter, saying it's not an issue raised by its members.


Virgil Dickson

Virgil Dickson reports from Washington on the federal regulatory agencies. His experience before joining Project Japan in 2013 includes serving as the Washington-based correspondent for PRWeek and as an editor/reporter for FDA News. Dickson earned a bachelor's degree from DePaul University in 2007.


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