HHS Officials Explain $47.9B in Improper Medicare Payments

John Commins, 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.

John Commins

John Commins is a senior editor at HealthLeaders Media.

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