Washington -- Improper payments for health care made up a large portion of
the $98 billion the federal government spent inappropriately in fiscal
2009. This total was an increase of $26 billion over the previous year,
according to a report issued by the White House Office of Management and
Budget.
The Nov. 17 report concluded that Medicare fee for service improperly spent
$24 billion in fiscal 2009, a rate equivalent to 7.8% of total outlays, and
Medicaid improperly spent $18 billion, a rate of 9.6%. Medicare Advantage
improperly spent $12 billion in 2009, a rate of 15.4% of total outlays on
the private plans.
The Medicare fee-for-service error rate was just 3.6% in 2008.
The Dept. of Health and Human Services attributed some of the stark
increase in improper payments to a new, more rigorous method of calculating
error rates, in keeping with President Obama's stated commitment to
reducing fraud and waste.
"Through a more stringent review of Medicare claims, we've been able to
establish a more complete accounting of errors, enabling the Centers for
Medicare & Medicaid Services to take more actionable steps to further
reduce the error rate and identify abusive or potentially fraudulent
actions before they become problems," said HHS Secretary Kathleen
Sebelius.
Sebelius also credited a joint fraud and abuse task force formed earlier
this year with the Dept. of Justice -- the Health Care Fraud Prevention and
Enforcement Action Team -- with improving oversight of Medicare funds.
Some payments for health services are labeled improper because they are
deemed to be medically unnecessary or because they lack proper
documentation. CMS said it is taking further steps to ensure that
physicians submit all required clinical and medical documents to support a
claim, that signatures on medical documents are legible and that a claims
history no longer can be used to fill in missing treatment documentation.
The agency said it also is using data from electronic records to detect
vulnerabilities in areas at high risk for fraud, abuse and waste -- such as
durable medical equipment and home health services.
The full and original article can be found here:
http://www.ama-assn.org/amednews/2009/11/30/gvsc1202.htm
Totale: $ 0
