Rise in improper payments
Improper payment levels continue dogging the Centers for Medicare and Medicaid Services, which announced they rose significantly last year for both health programs. Additionally, the agency reported that collections were down more than $1.5 billion.
The improper payment rate for skilled nursing facilities alone rose 60% last year — from the 6.94% rate in 2014 to 11.04%, CMS noted. The agency blamed much of the problem on the usual “insufficient documentation” woes haunting providers. Other leading causes included medical necessity and administrative or coding errors. CMS also used the opportunity to blame ongoing “wasteful” therapy overbilling issues as a concern.
Medicaid improper rates nearly doubled from 2013 to 2015 — from 5.8% to 9.78%. Federal regulators blamed much of the problem to states' compliance issues with new provider enrollment and screening requirements mandated under health care reform.
The HHS Inspector General, meanwhile, blamed a drop in investigations to an expected $1.5 billion decline in recoveries of improper payments. HHS said it wished more state fraud units would increase use of data-mining as a way to reduce improper payments. It recouped $3.35 billion last year, off from the previous year's total of $4.9 billion.