Medicare Tightens Controls to Catch More Improper
Fee-for-Service Payments in 2009
Part of administration-wide strategy to eliminate
errors and prevent waste and fraud
Nov. 20, 2009 HHS and CMS, the managers of the
Medicare program, announced this week it has taken actions to obtain
more complete information about errors so that the Agency can better
target improper payments in the Medicare fee-for-service (FFA) in 2009.
CMS has significantly revised and improved accounting in this program to
improve the identification of improper payments, according to the
announcement.
The Obama Administration is committed to
strengthening and improving the Medicare and Medicaid systems and doing
everything we can to be responsible and vigilant stewards of these
programs that millions of Americans rely upon, said HHS Secretary
Kathleen Sebelius.
From the very start of the Administration, the
President has directed all the agencies across government to use honest
budgeting and to take the hardest, most detailed look possible at what
was happening with taxpayer dollars inside our agencies and inside
critical programs.
This year, we made the call to stop calculating
our error rate in fee-for-service Medicare the way that the previous
Administration did and to start using a more rigorous method in
calculating this rate in keeping with our mandate to root out errors and
fraud.
The Medicare, Medicaid and Childrens Health
Insurance Program (CHIP) improper payment rates are issued annually as
part of the U.S. Department of Health and Human Services (HHS) Agency
Financial Report.
While improper payment rates are not necessarily an
indicator of fraud in Medicare or any other federal health care program,
they do provide HHS, CMS, and its partners who are responsible for the
oversight of Medicare and Medicaid funds a more complete assessment of
how many errors need to be fixed.
If we arent honest about the problem, there is no
way we can get to a solution. Through a more stringent review of
Medicare claims, weve been able to establish a more complete accounting
of errors, enabling CMS to take more actionable steps to further reduce
the error rate and identify abusive or potentially fraudulent actions
before they become problems, said Sebelius.
This change in calculating the error rate is just
one part of our larger Administration-wide effort to reduce waste, fraud
and abuse in health care. In addition to the establishment of HEAT, the
joint task force that was established earlier this year with the
Department of Justice, weve taken aggressive steps at HHS and CMS to
improve our oversight of the Medicare trust funds and the taxpayer
dollars that pay for the health care of millions of older and vulnerable
Americans.
As we move forward in our review of the Medicare
and Medicaid error rate data, we expect to be able to determine if there
are specific trends that can better help us identify weaknesses in our
programs or systems, said Acting CMS Administrator Charlene Frizzera.
We hope to be able to use data available through
the use of new electronic health record reporting that can help in the
design of new and innovative approaches to finding emerging trends and
vulnerabilities in high risk areas such as durable medical equipment and
home health.
Sebelius and Frizzera also pointed out the HHS and
the CMS would invest more time and resources into working with providers
to eliminate errors through increased and improved training and
education outreach.
Its important that we continue to work closely
with doctors, hospitals and other health care providers to make sure
they understand and follow the more comprehensive fee-for-service
requirements, said Frizzera. We are committed to working closely with
them to reduce the rate of improper payments.
