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HHS Officials Explain $47.9B in Improper Medicare Payments

John Commins, for HealthLeaders Media, July 29, 2011

The federal government issued $47.9 billion in improper payments to Medicare fee-for-service and Medicare Advantage in fiscal 2010, and Thursday officials from the Office of Inspector General, the Centers for Medicare & Medicaid Services, and the Government Accounting Office went before a House subcommittee to explain why. The House Subcommittee on Government Organization, Efficiency, and Financial Management heard testimony attributing the improper payments to a number of causes, primarily improper documentation.

"Some but not all improper payments are the result of fraud," Daniel R. Levinson, OIG's Inspector General told the subcommittee, in prepared remarks.

Levinson said improper payments can result from:

  • Unnecessary claims
  • Miscoded claims
  • Eligibility errors
  • Insufficient documentation

"Examples of improper payments include payments made to an ineligible recipient, duplicate payments, or payment for services not received," he added. "For example, my office recently identified $3.6 million in improper Medicare Part D payments on behalf of deceased beneficiaries."

Of the total $47.9 billion in improper payments identified, $34.3 billion were attributed to Medicare fee-for-service, representing a 10.5% error rate. The remaining $13.6 billion was attributed to Medicare Advantage, representing a 14% error rate, Levinson told the committee.

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1 comments on "HHS Officials Explain $47.9B in Improper Medicare Payments"


Dawn Smith (8/8/2011 at 12:26 PM)
Just graduating from a medical office specialist course, I had the opportunity to have classes that included patient billing and we briefly learned about billing and coding. Can I just say what a mess that system is! I cannot believe how many codes there are and having to [INVALID] them on a yearly basis. It's a wonder that there are so many mistakes. And why in these departments aren't questions being asked if one's not sure of how to bill a patient? There's got to be someone held accountable for such mistakes. It is out of control and ridiculous. Let's slow down a bit people and take the time to do the job right the first time!!!! Where's the support in these departments? Something's got to change and change like yesterday! Start cracking the whip supervisor's!!! The problem with some people is that they are there to punch in and punch out. There is no compassion for what they do in there jobs. There is no one there to stand up and call someone out on their poor behavior. Having people's treatments be eligible or not, to some can mean financial disaster. We are all trusting in our clinics/hospitals to have competent people do their jobs correctly so we don't have to worry about our visit(s). Lets take pride in our positions and if you can't, then get out of the business!