Medicare improper payment rate continues to fall - Updata - Brief Article - Statistical Data Included

Healthcare Financial Management, April, 2002

The HHS Office of Inspector General (OIG) has estimated that 6.3 percent of Medicare payments made in FY01, amounting to about $12.1 billion, were improper. This amount represents a 0.5 percent drop in the improper payment rate from FY00 and an almost 8 percent decline from the $23.2 billion in improper payments made by the Medicare program in FY96. The OIG defines improper payment as reimbursement to providers for medically unnecessary services, documentation deficiencies, and miscoding.

The OIG attributes the reduction in improper payments to CMS's diligence in monitoring the issue and developing appropriate corrective action plans. Nonetheless, the OIG recommends that CMS continue to refine Medicare regulations and guidelines and to better educate providers about the need for sufficient documentation in medical records.

To read the OIG's report, go to http://oig.hhs.gov/oas/reports/cms/aOI 02002.pdf.