CGS Administrators, LLC, did not reopen and recalculate most selected hospices’ caps for years prior to 2020
12/05/24 at 03:00 AM
CGS Administrators, LLC, did not reopen and recalculate most selected hospices’ caps for years prior to 2020
USA HHS Ofice of Inspector General (OIG), Washington, DC; issued 11/27/24, posted 12/4/24
Why OIG Did This Audit: ... Our audit determined whether CGS accurately calculated cap amounts and collected cap overpayments in accordance with CMS requirements. This audit is part of a series that reviewed MAC calculations and collections of hospice aggregate and inpatient cap overpayments.
What OID Recommends: [... that CGS]
- discontinue its practices that limited the reopening of prior years’ cap calculations and start reopening all prior years’ cap calculations,
- revise policies and procedures so that it meets the reopening deadlines established in the Federal requirements, and
- conduct the prior years’ hospice cap calculations for the five hospices with UPIC recoupments and collect any additional overpayments.
CGS concurred with our second and third recommendations and partially concurred with our first recommendation.