Recovering Overpayments from Providers Who Share TIN

CMS is authorized to make any necessary adjustments to the payments of a provider of services or supplier who shares a TIN with a provider of services or supplier that has an outstanding Medicare overpayment. The Secretary of Health and Human Services is authorized to adjust the payments of such a provider of services or supplier regardless of whether it has been assigned a different billing number or NPI from that of the provider of services or supplier with the outstanding Medicare overpayment.

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In January 2016, CMS enhanced its enforcement capabilities to recover amounts due the Medicare program.  These enhancements allow CMS to make adjustments to payments to a provider who shares a tax identification number with another provider that has an outstanding Medicare overpayment.  This recoupment can happen across mutliple states within a MAC jurisdiction.

What this means is that a provider who owes Medicare for an overpayment cannot simply close down and join another practice to escape the debt.  CMS can now reduce payments of the new practice for the debt owed by the new provider.

A recent Medicare Learning Network article summarizes the rule here.  Details of the authorization can be found in section 1866j(6) of the Social Security Act.

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