Improper Medicare payments continue to drop
6.8% of payments now in error
Improper Medicare payments to doctors, hospitals, and other health care providers in fiscal year 2000 continued to fall, notes an Office of the Inspector General (OIG) report. Medicare’s estimated error rate was 6.8% in fiscal year 2000, compared with nearly 8% the previous year, according to the OIG. The goal for FY 2002 is 5% or less. The error rate has fallen to roughly half of the 14% rate estimated in fiscal year 1996, the first year that the OIG conducted an audit to estimate Medicare’s overall error rate.
"HCFA has made significant improvement toward assuring proper payment for medical services, but more must be done," HHS Secretary Tommy G. Thompson said. "Our challenge now is to keep improving Medicare’s management and to modernize and strengthen the program to ensure that we meet the long-term needs of our seniors and people with disabilities. "We must not only modernize Medicare’s accounting systems, but also make its rules and procedures more understandable and user-friendly. If we can make our programs and our coverage easier to understand, we’ll be helping physicians and other providers to avoid unintended errors, and we’ll help detect deliberate abuses as well."
The fiscal year 2000 error rate represents an estimated $11.9 billion in improper payments out of the total $173.6 billion in fee-for-service Medicare payments, compared with $13.5 billion in fiscal year 1999 and $23.2 billion in fiscal year 1996. The most common errors included:
— problems with insufficient or inappropriate back-up claim documentation;
— inaccurate coding of the services provided;
— no medical need for the services;
— Medicare did not cover the services provided under the claim.
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