Increased oversight, other efforts have reduced improper Medicare payment claims by $1.3B

Improved oversight and other efforts by CMS have helped reduce the rate of improper Medicare reimbursements for fee-for-service claims from 5.2% in 2005 to 4.4% in 2006 for a savings of $1.3 billion, according to agency Administrator Mark McClellan, CQ HealthBeat reports.

As part of the efforts, CMS conducted reviews of about 160,000 randomly selected Medicare fee-for-service claims submitted between April 1, 2005, and March 31, 2006.

CMS also worked with Medicare contractors to improve system edits, update coverage policies and direct provider education efforts.

From 2004 to 2005, CMS reduced the rate of improper Medicare reimbursements for fee-for-service claims from 10.1% to 5.2% for a savings of about $10 billion.

McClellan said in a statement, "We have been increasing our efforts to reduce improper Medicare claims payments, and, for the second year in a row, it's paying off. Because we are able to measure the accuracy of payments more closely now, we are able to target our efforts more effectively with Medicare contracts and providers."

Senate Finance Committee Chair Chuck Grassley (R-Iowa) said, "Every dollar that's misspent is a dollar that's not providing care for beneficiaries.

Today, while Medicare is still paying for medically unnecessary services and undocumented or poorly documented services, we see a major reduction that deserves recognition" (CQ HealthBeat, 10/12).