Corporate Compliance

CMS reports improper FFS payments declining

Healthcare Auditing Weekly, November 25, 2008

CMS reported a decrease in Medicare fee-for-service improper payments, from 3.9 percent in fiscal year 2007 to 3.6 percent in FY2008, protecting about $400 million of taxpayer money.

The Medicare, Medicaid, and State Children’s Health Insurance Program (SCHIP) improper payment rates are issues annually as part of the HHS Agency Financial Report, according to CMS’ press release.
 
Improper payment rates include payments that CMS maybe paid incorrectly, and do not always reflect fraud. Improper payments for Medicare FFS are due to claims for services that were medically unnecessary or incorrectly coded. Errors in Medicaid and SCHIP are due to inadequate documentation, lack of information to support the provider’s FFS, or the provider did not provide additional data when CMS requested it.
 
CMS’ aggressive efforts have lead to a decline in Medicare FFS improper payments from about 14 percent in 1996 to 3.6 percent in FY2008.

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