Recovery of Improper Payments and Debts Sample Clauses

Recovery of Improper Payments and Debts. Not applicable, because data from the Marketplace matching programs are not currently used to identify and recover improper payments and debts. The Patient Protection and Affordable Care Act, Public Law No. 111-148, as amended by the Health Care and Education Reconciliation Act of 2010, Public Law No. 111-152 (ACA) requires that each state develop secure electronic interfaces for the exchange of data under a matching program using a single application form for determining eligibility for all state health subsidy programs. CMS has entered into matching agreements with the following federal source agencies: 1) Social Security Administration (SSA), 2) Department of Homeland Security (DHS), 3) Internal Revenue Service (IRS), 4) Veterans Health Administration (VHA), 5) Department of Defense (DoD), 6) Office of Personnel Management (OPM), and 7) the Peace Corps. In addition, CMS has developed a matching program that is executed with every state AE, including state Medicaid and CHIP agencies and State-based Marketplaces. CMS designed the Federal Data Services Hub (Hub) to be a centralized platform for the secure electronic interface that connects all AEs and trusted data sources. Without the Hub, each State AE would be required to enter into a separate arrangement with each federal agency to determine whether applicants for state health subsidy programs are eligible for coverage. If the match operations were conducted through separate arrangements outside of the Hub, the costs to CMS, the source federal agencies, the AEs, and consumers (applicants) would be significantly greater than under the current structure. CMS has made the following assumptions in developing this CBA: • The ACA does not expressly mandate the use of computer matching, but effectively requires it by requiring a single streamlined application process for consumers. Because matching must be conducted to provide the single, streamlined application process Congress required (i.e., is not optional), this CBA does not evaluate whether the matching programs should be conducted versus not conducted, but rather it evaluates whether the matching programs are efficiently structured and conducted, and whether the current structure is less costly than an alternative structure. • Eight matching programs are currently operational. CMS receives data from seven source federal agencies (IRS, DHS, SSA, OPM, Peace Corps, VHA, and DoD) under separate CMAs. Under an eighth CMA, CMS makes the data from those seven ...

Recovery of Improper Payments and Debts not applicable Key Element 4 is not applicable, because data from the Marketplace matching programs is not currently used to identify and recover improper payments and debts, as this is not a primary goal of the matching programs. Annual reconciliation and recovery of improper tax payments are performed by the IRS through a process that is independent of the Marketplace matching programs and other CMS eligibility determination activities. While the Marketplace matching programs could provide for annual and monthly reporting of data by Marketplaces to the IRS and consumers for the purpose of supporting IRS's annual reconciliation, annual and monthly reporting is not currently an activity covered in the IRS-CMS CMA; rather, that information is exchanged between the agencies through Information Exchange Agreements. At most, the data used in the Marketplace matching programs has the future potential benefit of being used in an analytical form, to assist IRS in identifying and/or recovering improper payments and debts.

Recovery of Improper Payments and Debts. Data from the matching program is not currently used to identify and recover improper payments. Annual reconciliation and recovery of improper payments is ultimately performed by the IRS through a process that is also independent from CMS’s eligibility activities, including this computer matching agreement. Because data matches under this computer matching program are not used for recovery of improper payments, there are no benefits to estimate in this category. While annual and monthly reporting by Marketplaces to the IRS and consumers is a way of Marketplaces providing data to support IRS’s reconciliation, annual and monthly reporting is not an activity covered in the IRS-CMS CMA and therefore is outside the scope of this study. As these uses are not allowed under the CMAs being entered into at this time, there are currently no benefits to quantify in this category for agencies, clients or the general public.

Recovery of Improper Payments and Debts. To Agencies – • Source Agency (OCSE) – N/A • Recipient Agency (SSA) – N/A • Justice Agency – N/A To Clients – N/A To the General Public – N/A

Recovery of Improper Payments and Debts. Quarterly Batch Matching Operation No. of Alerts Completed by FO in FY 2015:‌ S2 -13,568‌ U5 -999‌ Percent of Records with Improper Payments‌ 58.0%‌ 31.0%‌ Number of Alerts with Improper Payments 7,870 310 Total Improper Payment (Projected)‌ $10,191,650‌ $381,300‌ Total Benefit‌ $930,975,567 Supplemental Batch To establish and verify Individual's Social From the Quarterly Wage File: quarterly SSA claims Quarterly wage record National 42 U.S.C. §

Recovery of Improper Payments and Debts. To Agencies • Source Agency: OCSE • Recipient Agency: SSA Between October 2019 and September 2020, the FOs worked 251,366 S2 cases and 11,342 U5 cases. We found retroactive overpayments in 24.5 percent of the S2 cases. The average retroactive overpayment is approximately $864. Projecting these results to the universe of S2 alerts released to the FO in FY 2020, we estimate that 61,585 cases have retroactive overpayments, with a total estimated overpayment detected from the match of approximately $53,209,440. Using the average historical recovery rate for Title XVI, we would expect to recover 65 percent of the overpaid dollars for a total benefit of approximately $34,586,136. We found retroactive overpayments in 12.3 percent of the U5 cases. The average retroactive overpayment is approximately $989. Projecting these results to the universe of U5 alerts released to the FO in FY 2020, we estimate that approximately 1,389 cases have retroactive overpayments, with a total estimated overpayment detected from the match of approximately $1,373,721. Using the average historical recovery rate for Title XVI, we would expect to recover 65 percent of the overpaid dollars for a total benefit of approximately $892,919 • Justice Agencies: N/A To Clients: N/A To Third Parties: N/A These matching operations result in an overall savings of about $1,258,066,286. The total costs are approximately $336,668,578. These actual savings to the United States Treasury makes this matching operation cost effective with a benefit to cost ratio of 3.74:1. We note that SSA temporarily suspended processing and collection of some overpayments between March and September 2020 due to the Covid-19 pandemic. In addition, we found that many reviews conducted by the FO combined the effects of both wages and unearned income from Covid-19 related assistance (e.g., Economic Impact Payments)1. Since we only count records where we can identify this match as the sole cause of detecting an improper payment or adjusting a payment, the numbers and amounts of improper and adjusted payments that should have been detected through this match may be understated. Therefore, this matching operation 1 SSA determined that most Covid-related financial assistance would not affect eligibility for SSI or the monthly SSI payment amount. However, prior to this determination, SSA counted pandemic relief payments as income for the purposes of determining SSI eligibility and payment amounts. The agency is currently reviewing...

Recovery of Improper Payments and Debts. Data from the Matching Program is not currently used to identify and recover improper payments. Annual reconciliation and recovery of improper payments is ultimately performed by the IRS through a process that is also independent from CMS’s eligibility activities, including this computer Matching Program. Because data matches under this computer Matching Program are not used for recovery of improper payments, there are no benefits to estimate in this category. While annual and monthly reporting by Marketplaces to the IRS and consumers is a way through which Marketplaces provide data to support IRS’s reconciliation, annual and monthly reporting is not an activity covered in the IRS-CMS CMA, or any other CMAs covered under this cost- benefit analysis, and therefore, is outside the scope of this study. As these uses are not allowed under the CMAs being entered into at this time, there are currently no benefits to quantify in this category for agencies, clients, or the general public. Attachment 2 BETC: DISB ESTIMATED COST OF SERVICES: FINANCING (Check one): ADVANCE (in Full) PAYMENT) x

Recovery of Improper Payments and Debts. Quarterly Batch Matching Operation

Recovery of Improper Payments and Debts not applicable