- HHS failed to keep improper payments under the Medicare Fee-for-Service (FFS) plan below the 10% threshold required by law in fiscal 2015, according to a report released Thursday by the Office of Inspector General.
- The error rate of 12.1% was largely due to insufficient documentation and medical necessity errors.
- The OIG reiterated earlier recommendations for reducing the improper payments rate to below the compliance threshold.
This is the third year that Medicare FFS has exceeded the threshold, which means HHS will now have to submit plans to Congress for coming into compliance.
Improper payments for the plan, which covers hospital and medical services for seniors, totaled $125 billion between 2013 and 2015, Bloomberg reported. HHS’ overpayment rate was 10.1% in 2013 and 12.7% in 2014.
An earlier study by the Government Accountability Office found more than $14 billion in improper payments were made to the Medicare Advantage program in fiscal 2013.
While HHS did meet many of the requirements of the Improper Payments Information Act of 2002, which requires an annual report of information on payment errors, it failed to fully comply with several other requirements as well, the report notes.
The unmet requirements included failing to conduct risk assessments of payments to employees and charge card payments; failing to meet improper payment rate reduction targets for Medicare Advantage, Medicaid, the Children’s Health Insurance Program and the Child Care Development Fund; and not performing recovery audits for Medicare Advantage.
The report stems from an audit by Ernst & Young, which is reviewing payments in several HHS programs.
HHS Assistant Secretary for Financial Resources Ellen Murray said the department “has taken, and continues to take,” a number of actions to address root causes” of improper payments.