Improper Medicaid Payments Skyrocket over $36 BILLION

‘Eventually this all adds up to real money…’

Medicaid Enrollees to Increase by 40,000,000 Under Obamacare(Kaylee McGhee, Liberty Headlines)Improper payments made by the federal Medicaid program climbed from $29 billion in 2015 to more than $36 billion in 2017, according to the Department of Health and Human Services.

The House Oversight and Government Reform Committee held a hearing on April 12thto address the spike, which ended up being a 26 percent increase.

“Despite efforts to reduce improper payments in the Medicaid program by the Centers for Medicare & Medicaid Services, which oversees the program, overall improper payments continue to increase—rising to about $37 billion in fiscal year 2017 compared to $29.1 billion in fiscal year 2015,” GAO Health Care Director Carolyn Yocom told the House Oversight and Government Reform Committee during her testimony. “The size and complexity of Medicaid make the program particularly vulnerable to improper payments—including payments made for people not eligible for Medicaid or made for services not actually provided.”

Yocom said that due to concerns about inadequate oversight, Medicaid has been on the GAO’s high-risk list since 2003.

Improper payments, according to the GAO, are “any payments that should not have been made or that was made in an incorrect amount, including overpayments and underpayments, under statutory, contractual, administrative, or other legally applicable requirements.”

“It includes any payment to an ineligible recipient, any payment for an ineligible service, any duplicative payment, payment for services not received (except where authorized by law), and any payment that does not account for credit for applicable discounts,” GAO says.

During the hearing, Rep. Jamie Raskin, D-Md., said 10.1 percent of payments were improper in the 2017 fiscal year.

The HHS annual financial reports confirmed this: There was a $7,581,450,00 increase over two years. In fiscal 2017, HHS reports that there were $36,447,950,000 in overpayments and $283,180,000 in underpayments.

HEARING: Federal agencies illegally pass hundreds of regulations per year

Mark Meadows/IMAGE: YouTube

Rep. Mark Meadows, R-NC, said improper payments are a problem that “encompass the entire federal government.”

“Eventually this all adds up to real money,” he said during the hearing. “There are trillions of tax payer dollars that are unaccounted for — all for one federal program.”

But as recently as November 2017, the federal Centers of Medicare and Medicaid Services reported that the rate of improper payments was the lowest it had been since 2013, accounting for less than 10 percent of overall Medicare and Medicaid payments.

The CMS estimated that improper payments dropped $4.9 billion from 2016 to 2017, dropping from 11 percent to 9.5 percent in one year.

It was the first time since 2013 that the Medicare fee-for-service improper payment rate was below 10 percent, according to the agency.

CMS attributed this drop to its increased efforts to crack down on fraudulent payments, saying it had developed a multifaceted strategy, including a targeted claims auditing process that focuses on high-risk providers.

“We still have work to do,” Kimberly Brandt, principal deputy administrator for operations, said in a statement. “We remain committed to collaborating across CMS and with stakeholders to address potential vulnerabilities and continuing to strengthen our program integrity efforts, while minimizing burden for our partners.”

But Meadows said during the hearing that improper payments remain a big problem and that the amount of fraudulent payments only continues to grow.

“I’m one who believes that not every improper payment is necessarily the result of a bad actor,” Meadows said. “But 20 years later since the start of Medicare and this is still a problem.”

Meadows said the HHS accounts for the largest amount of improper payments, and that one of they keys to solving this ongoing problem is “restoring departmental integrity by having complete, accurate, and timely data.”

Raskin agreed, saying the federal agencies need to work with the states to create an efficient solution.

“All 50 states’ Medicaid agencies, along with the federal centers of Medicare and Medicaid services, must work together to lower the rate of improper payments, not only in the interest of preserving our tax dollars, but also because fraud and inefficiency threaten the stability of Medicaid and deprive enrollees of the benefits that they rightfully rely on,” he said.

Meadows said improper payments need to be tackled because the problem directly effects the taxpayers.

“It is the people’s money,” he said. “And sometimes we forget that it’s people that pay their taxes each and every day.”

e of improper payments, not only in the interest of preserving our tax dollars, but also because fraud and inefficiency threaten the stability of Medicaid and deprive enrollees of the benefits that they rightfully rely on,” he said.

Meadows said improper payments need to be tackled because the problem directly effects the taxpayers.

“It is the people’s money,” he said. “And sometimes we forget that it’s people that pay their taxes each and every day.”