Medicare Overpayments for Chronic Care Management Services

On November 7, 2019, the Office of the Inspector General issued the final report of audit findings and recommendations related to Chronic Care Management Services. Providers should continue to use information outlined in the OIG report to help assure compliance with Medicare guidelines when providing and billing these services.

The OIG findings are outlined in the Office of Inspector General’s (OIG) final report, Medicare Made Hundreds of Thousands of Dollars in Overpayments for Chronic Care Management Services. 

Medicare overpayments were identified during this audit for the following situations.

• Providers billed noncomplex or complex CCM services more than once for the same beneficiary for the same service period
• The same provider billed for both noncomplex or complex CCM services and overlapping care management services rendered to the same beneficiaries for the same service periods
• Incremental complex CCM services that were billed along with complex CCM services

More information regarding Medicare coverage of chronic care services is available on the CMS Care Management web page.