Feds tighten Medicare plans oversight to curb improper payments

The Centers for Medicare & Medicaid Services announced an initiative Friday designed to reduce the number of Medicare advantage payments made in error.

The Associated Press: Feds To Curb Improper Payments To Medicare Plans
The Obama administration says it's taking steps to fix a longstanding problem of improper payments to private health plans that serve 1 in 4 Medicare beneficiaries. So-called Medicare Advantage plans face tighter audits under a policy issued Friday. The rules say Medicare must pay the plans a higher rate to care for sicker beneficiaries. But previous government audits discovered many claims were not backed up by proper medical documentation (2/24).

Politico Pro: CMS Tightens Medicare Advantage Oversight
Federal health officials will tighten their oversight and audit procedures under a new initiative to reduce payment errors made to Medicare Advantage plans. The tighter audits will focus on the additional payments Medicare makes to private insurers to help offset the cost of treating sicker patients. On Friday, CMS officials said they expect to recoup as much as $370 million in the program's first year. From 2010 through 2011, CMS reduced the payment error rate by three percentage points, going from 14.1 percent down to 11 percent. The downward trajectory is expected to continue, with the agency projecting a 10.4 percent rate this year, and 9.8 percent in 2013 (Dobias, 2/24).

Modern Healthcare: New Initiative Reclaims $370 Million In Overpayments, CMS Says
A new effort from the CMS to reduce improper payments in Medicare Advantage plans is estimated to recover about $370 million in overpayments for the first year, the agency announced Friday. Medicare Advantage organizations are required to submit data to the CMS to receive risk-adjustment payments, and 2010's Improper Payments Elimination and Recovery Act requires that the CMS audit these data each year (Zigmond, 2/24).

Modern Healthcare: Advantage Plans Vary On Fraud Detection: Study
Medicare Advantage insurers lack a "common understanding" about federal anti-fraud requirements and that may limit their ability to detect and mitigate the problem, according to a broad review of those entities by HHS' inspector general's office. The agency study of insurers covering 94 percent of Medicare beneficiaries enrolled in Medicare Advantage plans in 2009 found wide variation in the rate of potential fraud incidents flagged by plans and in their rate of reporting those incidents for further investigation (Daly, 2/24).