Regulators Warn Against Improper Billing of Medicare Recipients

Two federal agencies warned healthcare providers, Medicare Advantage plans and debt collectors not to improperly bill Qualified Medicare Beneficiary recipients (QMBs), who generally cannot be billed for cost-sharing by healthcare providers who accept Medicare.

The Consumer Financial Protection Bureau (CFPB) and the Centers for Medicare & Medicaid Services (CMS) said in a Friday (Nov. 1) press release that their joint statement will protect millions of QMBs who are living at or below the poverty line.

“The CFPB and CMS are working to ensure that Medicare beneficiaries are not subjected to illegal debt collection on improper medical bills,” CFPB Director Rohit Chopra said in the release.

CMS Administrator Chiquita Brooks-LaSure said in the release: “This guidance is part of our ongoing commitment to ensure people have access to healthcare without fear of receiving bills that they should not have to pay.”

About 11% of the Medicare-related complaints received by CFPB over the last several years are from QMBs reporting that a healthcare provider or debt collector attempted to collect debts that are not owed, according to the release.

Traditional Medicare providers and suppliers, Medicare Advantage providers and suppliers, and debt collectors can be sanctioned by CMS or be liable under federal law if they improperly bill QMBs, the release said.

The CMS also clarified Thursday that healthcare providers must refund any improper charges, regardless of whether Medicare Advantage plans provided them with incorrect information about a recipient’s QMB status, per the release.

In an earlier, separate statement, the CFPB said Oct. 1 that it is targeting illegal practices among medical debt collectors.

These practices include “double-dipping” to get paid for services covered by insurance, harassing consumers to pay “fake or exaggerated charges,” misrepresenting consumers’ rights to contest bills, and collecting debts without documenting that the amount is owed.

In July, the CFPB issued a report in which it said it found numerous complaints centered on credit cards offered by dental and medical practices.

The regulator’s examination found a “significant number of consumer complaints” on how dentists and other healthcare providers promoted or sold medical credit cards to their patients, by misrepresenting things like “deferred interest” promotions or pressuring consumers to open these cards while undergoing treatment.