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Analysis

CMS: Medicare FFS Improper Payments Down $15B Since 2016

By Jack O'Brien  
   November 17, 2020

The decline was due in part to improvements in home health, including a $5.9 billion decrease in estimated improper payments from FY 2016 to FY 2020.

Medicare fee-for-service (FFS) improper payments have declined by $15 billion since 2016, according to a report released by the Centers for Medicare & Medicaid Services (CMS) Monday.

The Medicare FFS estimated improper payment rate fell to 6.27% in fiscal year (FY) 2020, down from 7.25% in FY 2019. Skilled nursing facility claims experienced a $1 billion reduction in improper payments last year as the result of a policy change and other regulatory efforts taken by CMS.

This marked the fourth consecutive year where the Medicare FFS improper payment rate was below 10%, according to CMS.

Related: Fewer Physicians Accepting Industry Payments, But Payment Values Stay Steady

The decline was due in part to improvements in home health, including a $5.9 billion decrease in estimated improper payments from FY 2016 to FY 2020.

The agency also attributed the $15 billion reduction to efforts that identified the causes of improper payments, implemented action plans to correct them, and extended CMS' capacity to "address emerging areas of risk through work groups and interagency collaborations."

"President Trump made a clear commitment to protect Medicare for our seniors, and to do that we must ensure that fraud and abuse doesn’t rob the program of precious resources," CMS Administrator Seema Verma said in a press release. "From the beginning this administration has doubled down on our commitment to protect taxpayer dollars and this year’s continued reduction in Medicare improper payments is a direct result of those actions."

Related: CMS Administrator Seema Verma Discusses Price Transparency, Value-based Care, and COVID-19

CMS' findings were released just over a month after the agency announced nearly a dozen new telehealth services would be included in Medicare FFS during the ongoing COVID-19 Public Health Emergency.

Related: CMS Expands Medicare FFS Telehealth Services

Jack O'Brien is the finance editor at HealthLeaders, a Simplify Compliance brand.


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