CMS Claims Improper Medicare Payments Are Down $15B

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According to new findings from the Trump Administration, the Centers for Medicare & Medicaid Services has seen a massive decline in the number of improper payments under Medicare fee-for-service by $15 billion since 2016.

“President Trump made a clear commitment to protect Medicare for our seniors, and to do that we must ensure that fraud and abuse doesn’t rob the program of precious resources,” said CMS Administrator Seema Verma in an announcement.

“From the beginning, this administration has doubled down on our commitment to protect taxpayer dollars and this year’s continued reduction in Medicare improper payments is a direct result of those actions,” added Verma.

Improper Medicare payments

The data from CMS revealed that the Medicare FFS improper payment rate declined to 6.27 percent in fiscal year (FY) 2020 from 7.25 percent in FY 2019. It was the fourth consecutive year that the Medicare FFS improper payment rate was below 10 percent, reported CMS.

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Medicare FFS improper payments decreased the most in the at-home healthcare sector. CMS reported $5.9 billion in savings attributed to fewer improper payments to home health agencies between FY 2016 and 2019. The agency also claims to have made a $1 billion reduction in improper payments possible to skilled nursing facilities in 2019.

Reductions in both the at-home health and skilled nursing facility improper payment rates can be attributed to CMS efforts to educate providers through the Targeted Probe and Educate program, as well as changes to the policy related to supporting information for physician certification and recertification for skilled nursing facility services, CMS stated.

CMS moving forward

The Centers for Medicare & Medicaid Services has made it clear that seeking a lower cost for taxpayers is their top priority. To achieve its goal, the agency has developed a five-pillar program integrity strategy for reducing improper payments.

CMS’s strategy is as follows: to stop bad actors who have defrauded federal healthcare programs; prevent fraud; mitigate emerging programmatic risks related to value-based payment programs; reduce provider burden; and leverage new technology (e.g., artificial intelligence and machine learning).

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