Wednesday, July 16, 2014

5.8% (or $14.4 Billion) of Medicaid Payments are Improper. 57% of Those Are Basic Human Errors

This is from Robert Radick writing at Forbes:
... [A]ccording to CMS, “5.8 percent of all Medicaid payments made in fiscal year 2013 were improper, representing $14.4 billion in Federal expenditures.” The government frequently cites to such massive figures as proof of rampant fraud, waste, and abuse that allegedly exists in government health care programs. But in fact, the HHS-OIG report provides some much needed perspective, indicating that 57% of the “improper” Medicaid payments result from more prosaic, mundane issues, such as the “eligibility errors” that arise when a beneficiary moves from one state to another and does provide Medicaid with a change of address. Fraud in the Medicaid program may still be a dramatic problem, but when “improper payments” are the result of such “eligibility errors” rather than fraud, the true scope of the problem can better be understood. ...