|
 |
 |
|
Hearing highlights staggering cost of improper Medicare payments
The federal government wasted almost $48 billion in improper payments in Medicare last year, the most of any government program, federal officials testified Thursday.
The Government Accountability Office (GAO) released a new report Thursday to coincide with a hearing of the House Oversight Committee's panel on government efficiency. The report found that the Health and Human Services Department has been making progress in cutting back on improper payments, but has a long way to go.
Improper payment estimates cover both overpayments and underpayments and include improper documentation, medically unnecessary services, coding and billing errors and payment calculation errors. Fraud is partly to blame, but the full cost of fraud in the program isn't known because the process to estimate improper payments isn't designed to detect or measure fraud.
The administration announced last year its intention to halve the error rate to 6.2 percent by next year, and HHS deputy chief operating officer Michelle Snyder testified Thursday that it "is making progress in meeting that goal."
The improper payment rate in the Part C Medicare Advantage program is even higher — 14.1 percent — while a composite error rate for the Part D prescription drug program is still being developed. Unlike the fee-for-service parts of the program, Medicare prospectively pays Part C and Part D plans a monthly capitated payment.
The GAO has identified Medicare as a high-risk program "because of its size, complexity and susceptibility to improper payments." Medicare receives about 4.8 million claims every day — some 1.2 billion this year — and its improper payments account for 38 percent of the federal government's estimated $125.4 billion in improper payments, according to GAO.
"Despite progress made by CMS," the GAO report concludes, "reducing improper payments in the program is a continuing challenge for CMS due to the size and scope of Medicare."
