Federal Report Finds Billions in Improperly Paid Medicare Claims
A new federal report has found that the government paid $47 billion in questionable Medicare claims in fiscal year 2009, illustrating the challenges the government could face as it seeks to pay for health reform by reducing fraud, the AP/Detroit Free Press reports.
The Associated Press obtained the report.
According to the report, the figure represents about 12.4% of spending in Medicare's fee-for-service program. It is unclear whether fraud is actually worsening because much of the increase in possible fraud over the last year is due to changes in HHS methodologies.
The report indicates that from 2005 to 2008, the Bush administration reported that 4% of Medicare payments were improper -- or about $17 billion in 2008 alone. During that time, officials did not consider a payment improper if it lacked complete documentation or if the provider's signature was illegible -- even though these factors typically bar payment.
Critics said that fraud figures during that period therefore were understated.
For FY 2009, the Obama administration did count those claims as improper, but a complete tally could not be tabulated based on the new methodology.
Using the new formula, the report officially lists a partial improper payment tally of 7.8% but noted that the unofficial 12.4% figure is more accurate.
The federal government is hoping to reduce improper payments in the program to 9.5% next year, resulting in savings of $9.7 billion.
The report also found that 9.6% of Medicaid claims, or about $18.1 billion, are improperly paid.
Next week, President Obama is expected to announce new efforts to crack down on Medicare fraud, including a government Web site to provide a more comprehensive account of health care spending.
CMS also is launching its own Web site next month that will allow users to track Medicare payments by state, diagnosis and hospital (Yen, AP/Detroit Free Press, 11/14).
Warnings of Fraud Ignored
CMS also is coming under scrutiny because of records indicating that for three years, it ignored internal watchdog warnings of fraud in several programs, the AP/Boston Globe reports.
The records were provided to the AP by Sen. Chuck Grassley (R-Iowa), ranking member of the Senate Finance Committee.HHS Secretary Kathleen Sebelius said the agency is implementing new processes for tracking warnings (Kennedy, AP/Boston Globe, 11/14). This is part of the California Healthline Daily Edition, a summary of health policy coverage from major news organizations. Sign up for an email subscription.