The Centers for Medicare and Medicaid Services (CMS) on July 11 released a new evaluation report showing that $693.6 million in improper Medicare payments was returned to the Medicare trust funds between 2005 and March 2008. The funds returned occurred after taking into account the dollars repaid to healthcare providers, the money overturned on appeal, and the costs of operating the RAC demonstration program.
Of the overpayments, 85 percent were collected from inpatient hospital providers; the other principal collections were 6 percent from inpatient rehabilitation facilities and 4 percent from outpatient hospital providers.
Most of the improper payments that the RACs identified occurred when healthcare providers submitted claims that did not comply with Medicare’s coverage or coding rules. The types of inadvertent errors leading to improper payments found by the RACs include billing for a procedure multiple times (for example, when a healthcare provider charged Medicare for conducting three colonoscopies on the same patient on the same day), incorrectly coded procedures, and submission of duplicate claims resulting in two payments to a provider.
The program began in California, Florida, and New York in 2005 and in July 2007 expanded to Arizona, Massachusetts, and South Carolina. Access the report.
