REIMBURSEMENT

By the Numbers: Improper Medicare Payments Hit 10-Year Low

As 2019 came to an end, CMS announced that the rate of improper Medicare payments during the year continued to decline, hitting its lowest point since 2010. Here are some of the key numbers:

  • $28.91 billion: Approximate amount of improper payments made by CMS in fiscal year 2019
  • 25: Percentage of fee-for-service Medicare claims that were improperly paid in FY 2019
  • $31.6 billion: Approximate amount of improper payments made by CMS in FY 2018
  • 12: Percentage of fee-for-service Medicare claims that were improperly paid in FY 2018
  • 3: FY 2019 is the third consecutive year that the improper payment rates was below 10%

Takeaway

Steadily declining rates of improper payments, which include overpayments, underpayments, fraudulent claims, payments distributed to the wrong recipient or for the wrong amount, payments with insufficient documentation and those when the recipient uses the funds improperly, is, of course, welcome news. But don’t expect regulators and enforcers to back off any time soon. On the contrary, CMS attributed the decline in improper payment rates to its “aggressive program integrity measures,” a strategy that’s sure to continue for the foreseeable future.

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