Palmetto GBA Alert Regarding Incarcerated Beneficiaries

Recently Palmetto GBA’s effort to recoup payments for services that had been provided to Medicare patients that were determined to be incarcerated on the dates of service, and therefore ineligible to receive Medicare benefits, was the subject of discussions between the North Carolina Medical Society (NCMS) staff and the members of the North Carolina Medical Group Managers (NCMGM). NCMS staff and NCMGM members voiced complaints directly to Palmetto GBA about (1) the fairness of this policy and (2) the accuracy of the determinations.

The Centers for Medicare and Medicaid Services (CMS) listened to the complaints and realized that the data they were working from was inaccurate.  As a result, they have, in large part, reversed course on this issue and many groups will be receiving payments back.

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