The CMS said improper Medicare claims declined to 3.9% in 2007 from 4.4% in 2006 and 14.2% in 1996the result of aggressive oversight efforts involving detailed data analysis in targeting areas where there might be waste, fraud and abuse. During the past three years, error-rate reductions in Medicare fee-for-service have led to approximately $11 billion less in improper payments, the CMS said. The CMS pays more than 1 billion fee-for-service claims each year. The report, which is released annually in November, was based on detailed reviews of randomly sampled Medicare claims submitted between April 1, 2006 and March 31, 2007. Approximately 140,000 claims were included in the Medicare error-rate testing program.
In addition to the Medicare error rate, the CMS said the preliminary results of the payment error-rate measurement program developed for Medicaidthe first year any improper Medicaid payments had been measuredwas 18.5%. The review was limited to 17 states, the first two quarters of fiscal 2006 and only one of three Medicaid payment areas (fee-for-service.) The CMS attributed the preliminary Medicaid fee-for-service error rate to insufficient supporting documentation necessary to verify claims accuracy. The agency said it intends to work closely with states to follow a similar approach it uses with the Medicare program. -- by Cinda Becker
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