Improper payments to fee-for-service Medicare amounted to $10.4 billion in fiscal 2008, decreasing to a rate of 3.6% from 3.9% in 2007, the CMS reported.
In targeting these errors, the agency estimates it saved $400 million over the past fiscal year.
In addition to fee-for-service payments, the CMS reported its first Medicare Advantage improper payment rate of 10.6%, or $6.8 billion, in payments made in calendar year 2006. These errors mostly reflected health plan errors in documenting members diagnoses.
Improper payment rates include payments that may have been paid incorrectly and do not necessarily reflect fraud. For Medicare fee for service, most improper payments are because of claims for services that were medically unnecessary or incorrectly coded, according to a CMS news release.
The CMS also reported for the first time the fiscal 2007 national composite error rates for Medicaid and the State Childrens Health Insurance Program. The CMS reported $32.7 billion in improper payments to Medicaid, of which the federal share was $18.6 billion, and $1.2 billion to SCHIP, with a federal share of $800 million.
Composite Medicaid and SCHIP rates are based on a weighted average reflecting fee-for-service and managed-care payments. They also include an eligibility component that measures improper payments for services provided to beneficiaries who were not eligible for Medicaid or SCHIP, or who were eligible for Medicaid or SCHIP, but not for the services they received under those programs.
The vast majority of Medicaid and SCHIP errors are due to inadequate documentation, the CMS reported. -- by Jennifer Lubell
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