Financial outlook is grim for not-for-profits, analyst says
Financial outlook is grim for not-for-profits, analyst says

The Centers for Medicare & Medicaid Services has taken steps to prevent improper Medicaid payments, but gaps still remain in making sure providers are properly vetted,  according to a federal report released Tuesday.

The Government Accountability Office acknowledged the efforts made by CMS to curb improper payments in its report, but noted that additional steps are needed to prevent such payments in the future.

“[Medicaid’s] size and diversity make it particularly vulnerable to improper payments, including payments made for treatments or services that were not covered by the program, that were not medically necessary, or that were never provided,” Carolyn L. Yocom, director of Health Care at the GAO, said in the report.

Improper payments were estimated to make up 10.5%, or $36 billion, of federal Medicaid expenditures in fiscal year 2016; that’s compared to the 9.8%, or $29 billion, reported for 2015. Despite the increasing rates, concerns over improper payments “are not new,” Yocom wrote.

Topping the government watchdog’s list of persisting Medicaid integrity issues were beneficiary and provider enrollment verification, boosting managed care oversight and better coordination between Medicaid and insurance exchanges.

The GAO had previously recommended that CMS identify databases that would improve oversight of Medicaid provider eligibility, along with working with other federal agencies to explore the option of a unique provider identifier. The agency has not yet taken those actions, the report reads, so inaccuracies may still exist when it comes to provider verification.

The report also recommends that CMS conduct a review of how the government determines if a beneficiary is Medicaid eligible, and develop a plan to ensure that its existing procedures to prevent and detect overlapping coverage from Medicaid and exchanges are sufficient.

CMS released its own plan to help cut back on the “significant and pervasive” nature of improper Medicaid payments in September.