Dive Brief:
- Medicaid's improper payment rate has almost doubled in the past two years, from 5.8% ($14.4 billion) in 2013 to 9.78% ($29.12 billion) in FY 2015, as per an HHS audit recently released.
- Dr. Patrick Conway, CMS chief medical officer, pointed to new provider enrollment and screening requirements under the ACA as driving the big increase and said without those requirements, the Medicaid improper payment rate would have dropped to 5.1%.
- States were required to implement Medicaid Recovery Audit Contractors (RACs) by Jan. 1, 2012, by the ACA, but have not proven very effective. Recoveries were only slightly up in 2015 to $57.71 million from $55.1 million in 2014.
Dive Insight:
Improper payments describe funds that either go to the wrong recipient, lack documentation to support a payment, the right recipient receives the wrong amount of funds, the recipient uses funds improperly, or fraudulent claims.
Dr. Conway explained increases often occur initially after new requirements but decrease after states and providers modify operations to comply with the new standards. "We believe, however, that these requirements will ultimately strengthen the Medicaid and CHIP programs, and that improper payment rates will again decrease with state and provider experience."
HHS plans to continue its outreach and education to states regarding federal requirements for Medicaid enrollment and screening with the goal of lowering improper payment rates.