Texas Clinics Repay Medicare for Improper Claims

Several Texas dialysis clinics in El Paso and the Dallas-Fort Worth area have had to repay Medicare for treating people in the country illegally.

TMA's Payment Advocacy Department Director Genevieve Davis says the practices had to write off the money recouped because they either could not find the patient or the patient is deceased. Ms. Davis added there is no way for a practice to verify a patient's legal status. If the patient has a Medicare card, the practice staff assumes the Centers for Medicare & Medicaid Services verified he or she is in the country legally.

The U.S. Department of Health and Human Services Office of Inspector General (OIG) said CMS did not determine the patients' status until after it paid the claims. It said CMS needs a better system to verify the legal status of patients. OIG defines a nonlawful resident as someone "who remains in the United States longer than the time authorized by U.S immigration agencies."

Nationally, the OIG reports Medicare improperly paid $91.6 million for treating illegal residents between 2009 and 2011.The agency pointed out that federal law allows Medicare payments for noncitizens legally present in the United States. 


Action, Feb. 1, 2013


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