"The C-Suite may not realize this is going on and has become an issue," says Hoy. "The point-of-care staff may not realize it's an issue either. This can be a lot of money. From the C-Suite standpoint, I think they need to have a dialogue with their local and state authorities and clear contracts for when they will and won't pay."
"I think that hospitals that are close to a prison already generally have this," says Hoy, "but other hospitals don't always think of it because it's not your every-day thing that occurs. But when it does, they are really going to be stuck if they haven't met and negotiated with the city and county and/or jail authorities in advance."
The OIG also announced January 24 that CMS made payments totaling $91.6 million to healthcare providers for services to approximately 2,600 unlawfully present beneficiaries during calendar years 2009 through 2011.
CMS, in a statement released to HealthLeaders Media, said that "for cases where Medicare is informed of patients' unlawful presence after claims have been paid, we are working with OIG to implement a process for quickly and completely recouping these improper payments."