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Errors in Medicare billing cost U.S. taxpayers $11.9 billion last year, according to the Health Care Financing Administration (HCFA). In March, the Office of the Inspector General (OIG) released its annual study of error rates in the Medicare program.
"This final report points out the results of our review of fiscal year (FY) 2000 Medicare fee-for-service claims," OIG officials reported. "Based on our statistical sample, we estimate that improper Medicare benefit payments made during FY 2000 totaled $11.9 billion, or about 6.8% of the $173.6 billion in processed fee-for-service payments reported by HCFA."
HCFA blames the errors on a wide range of reasons, from inadvertent mistakes to outright fraud and abuse. Since HCFA began tracking error rates in 1996, it has monitored Medicare payments and has instituted actions to limit errors, including working with provider groups to clarify reimbursement rules and impress upon providers the importance of fully documenting services. Additional initiatives on the part of Congress, HCFA, the Department of Justice, and the Office of Inspector General have focused resources on preventing, detecting, and eliminating fraud and abuse.
Continued vigilance is needed’
HCFA officials say their actions have contributed to reducing the improper payment rate by almost half since 1996. "However, continued vigilance is needed to ensure that providers maintain adequate documentation supporting billed services, bill only for services that are medically necessary, and properly code claims," OIG officials said. "These problems have persisted for the past five years. Our recommendations address the need for HCFA to sustain its efforts in reducing improper payments."