CMS: MEDICARE CONTINUES TO REDUCE IMPROPER CLAIMS PAYMENTS

The Centers for Medicare & Medicaid Services (CMS) announced today that aggressive oversight efforts have resulted in a further reduction of the number of improper Medicare claims payments, which declined from 14.2 percent in 1996, to 4.4 percent in 2006, to 3.9 percent in 2007. This solid improvement is a result of continued efforts initiated by CMS and its contractors to use detailed data analysis in targeting areas where erroneous claims processing, inaccurate billing and provider error result in waste, fraud and abuse.

The decline in improper payments reflects our emphasis on identifying and eliminating waste, fraud and abuse in all CMS programs. It is critical that we ensure every dollar is spent wisely so that the program is affordable for taxpayers and future generations of beneficiaries,� said CMS Acting Administrator Kerry Weems. The Medicare fee-for-service (FFS) error rate has declined from 14.2 percent in 1996, when the Medicare improper payment rate was first reported, to the current 3.9 percent in 2007. During the past three years, recent error rate reductions have led to approximately $11 billion less in improper payments. CMS pays more than 1 billion fee-for-service claims each year.

CMS conducted detailed reviews of randomly sampled Medicare FFS claims submitted between April 1, 2006 and March 31, 2007. Approximately 140,000 claims spanning all types of Medicare FFS payments were included in the Medicare error rate testing program. By providing accurate statistical information to its personnel and contractors, CMS can identify where problems exist and target improvement efforts to address the problems.

This year's results show the commitment to use more detailed data and analysis to identify and eliminate improper payments is working. Protecting the integrity and ensuring the accountability of CMS programs is one of our fundamental responsibilities, and we�re pleased with the improvement to the program, said Weems.

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