Latest News: Technology |  Celebrity |  Movies |  Apple |  Cars |  Business |  Sports |  TV Shows |  Geek

Trending

Filed under: News

 

Medicare Reports Fraud And Waste Grew In 2013 After Years Of Decline

Dec 20 2013, 3:01pm CST | by

10 Updates
Medicare Reports Fraud And Waste Grew In 2013 After Years Of Decline
Photo Credit: Forbes
 
 

Comments

Recommend Your Tweet as Top Tweet:

Full Story

Medicare Reports Fraud And Waste Grew In 2013 After Years Of Decline

Despite expanding its efforts to curtail fraud and waste, a Medicare internal auditor found that the agency’s fee-for-service program’s improper payments grew by almost 19 percent after years of decline.

In the U.S. Department of Health and Human Services annual financial report , published Dec. 16, Medicare’s Comprehensive Error Rate Testing (CERT) Program estimated that the agency improperly paid through fraud, waste, and errors, an additional $6.5 billion to healthcare providers over 2012. In all, Medicare paid more than $36 billion in erroneous fee-for-service claims, representing more than one dollar out of every 10 spent on beneficiaries for Medicare Parts A and B.

The almost 20 percent increase comes after three years of steady declines, from 10.8 percent in 2010 to a low of 8.5 percent last year. Overall, Medicare improper payments grew from $45 billion to $49 billion.

Neither HHS nor the Centers for Medicare and Medicaid Services (CMS) offered an explanation for the increase, other than issuing a pledge to investigate it. But the report is bad news for healthcare providers and for Medicare beneficiaries. While a percentage of those improper payments can be attributed to fraud, the majority represent fees paid for healthcare services that should have been absorbed, in part, by healthcare providers, and should have been paid, in part, by patients via Medicare Part B co-pays and co-insurance.

In a head-scratching press release, an organization representing Medicare’s private-sector auditors trumpeted the increase in fraud and waste . The American Coalition for Healthcare Claims Integrity, which represents private contractors who earn contingency fees for every misspent dollar by Medicare they find, yesterday sounded a PR-fueled clarion that healthcare providers – hospitals, physicians, clinics, labs, medical device manufacturers, and others – “falsely billed” Medicare for $49 billion in 2013, an increase of $5 billion from the year before.

These same Medicare auditors – called Recovery Auditors or Recovery Audit Contractors (RACs) – were established in recent years to make Medicare more efficient and eliminate waste. The increase is not the fault of the RACs, who have been hired to find improper payments, especially mistakes in Medicare claims made by hospitals and other providers. They are the Medicare equivalent of IRS auditors, but with one huge difference: They receive a contingency fee of 9 percent to 12.5 percent of every dollar of every mistake they find.

While their contracts contain language obligating them to educate healthcare providers about the mistakes they find, the RACs are incentivized to do exactly the opposite—the more errors  hospitals make on their claims, the more money RACs will earn. Their job is not to improve the system, but to profit off its inefficiencies. From a revenue-generating viewpoint, the RACs have been an overwhelming success. In 2013 they found $2.3 billion in past improper payments. But as a tool to reform Medicare, it has been a dismal failure. Medicare has become more slipshod and sloppy based on this current financial report.

So in at least one respect, the press release by the RAC organization makes perfect sense. For their investors this is fantastic news, for their employees it means job security—they have billions more dollars in Medicare waste to find.

Evan J. Albright is a contributing editor to title="iPF Home">insidePatientFinance.com . He lives in Massachusetts.

Source: Forbes

 

You Might Also Like

Updates


Sponsored Update

Update: 10

MRCB, Nusa Gapurna and PKNS settle suit over RM3 billion PJ Sentral project

Source: Malaysia Today

(The Malaysian Insider) – Malaysian Resources Corp Bhd (MRCB), Nusa Gapurna Development Sdn Bhd (NGD) and PKNS Holdings Sdn Bhd have reached an out-of-court settlement over the owners ...
Source: Malaysia Today   Full article at: Malaysia Today Jun 21 2014, 2:53am CDT
 


Advertisement


Update: 9

Story behind Syed Mokhtar’s ‘RM2.25 billion tax-exempt’ Bernas deal revealed, says PKR MP

Source: Malaysia Today

(The Malaysian Insider) – An innocuous written reply in Parliament has provided a peek into the cosy relationship between the Najib administration and Malaysia’s best-known businessman, Tan Sri Syed ...
Source: Malaysia Today   Full article at: Malaysia Today Jun 15 2014, 12:56pm CDT
 

More From the Web

Update: 8

Constitutional monarchy still murky concept

Source: Malaysia Today

After the RM4.5 billion land sale, the Sultan of Johor secured a 15% stake in MOL Access Portal (MOL) for RM396 million and took a 20% stake in Berjaya Times... ...
Source: Malaysia Today   Full article at: Malaysia Today Jun 14 2014, 12:37am CDT
 

Update: 7

Sultan of Johor’s RM4.5 bil backlash?

Source: Malaysia Today

49th Karlovy Vary International Film Festival
Has Sultan Ibrahim of Johor’s succession of big money deals over the last six months caused the tide of public opinion to turn against Johor’s royal palace? KiniBiz examines the... READ MORE ...
Source: Malaysia Today   Full article at: Malaysia Today Jun 11 2014, 8:49am CDT
 

Update: 6

Putrajaya denies carpet dealer given interest-free loan

Source: Malaysia Today

Eileen Ng, The Malaysian Insider Putrajaya today refuted allegations that Bank Rakyat had allowed carpet dealer Deepak Jaikishan to repay a RM32 million loan without interest following intervention from a... READ MORE ...
Source: Malaysia Today   Full article at: Malaysia Today Jun 11 2014, 5:44am CDT
 

Update: 5

Malaysia Spends Over $9 million on MH370 Hunt: Report

Source: NDTV

49th Karlovy Vary International Film Festival
Malaysia has so far spent about RM27.6 million (over $9 million) on search operations for missing Malaysia Airlines flight MH370, an off ...
Source: NDTV   Full article at: NDTV Jun 9 2014, 3:12am CDT
 

Update: 4

Bill for Kidex likely to soar to RM3.4b

Source: Malaysia Today

The original RM2.4 billion tag on the proposed highway did not take into account the cost of acquiring the land mostly in the urban areas, claims an assemblywoman Fabian Come ...
Source: Malaysia Today   Full article at: Malaysia Today Jun 9 2014, 2:51am CDT
 

Update: 3

MACC: No elements of graft in Bank Rakyat’s loan to businessman

Source: Malaysia Today

BET AWARDS '14 - Red Carpet
(Bernama) – The Malaysian Anti-Corruption Commission (MACC) found no elements of corruption in Bank Rakyat’s RM32 million interest free loan to a businessman. MACC in a statement today said initial... READ MORE ...
Source: Malaysia Today   Full article at: Malaysia Today May 31 2014, 9:33am CDT
 

Update: 2

IHH Healthcare posts 25% rise in 1Q earnings to $62 mil

Source: The Edge Singapore

IHH Healthcare Berhad announced that revenue grew by 8% y-o-y to RM1.8 billion ($703 million) for 1Q2014 ended March, as earnings grew 25% YoY to RM159.1 million. Read m ...
Source: The Edge Singapore   Full article at: The Edge Singapore May 29 2014, 11:29am CDT
 

Update: 1

Hasan Malek evades media over RM32 million Bank Rakyat loan scandal

Source: Malaysia Today

Elizabeth Zachariah, The Malaysian Insider The minister embroiled in the RM32 million Bank Rakyat loan scandal refused to take questions from the press today at an event in Kuala Lumpur.... READ MORE ...
Source: Malaysia Today   Full article at: Malaysia Today May 28 2014, 11:42pm CDT
 

Shopping Deals

 
 
 

<a href="/latest_stories/all/all/31" rel="author">Forbes</a>
Forbes is among the most trusted resources for the world's business and investment leaders, providing them the uncompromising commentary, concise analysis, relevant tools and real-time reporting they need to succeed at work, profit from investing and have fun with the rewards of winning.

 

 

Comments

blog comments powered by Disqus

Latest stories

 
Jennifer Aniston and Justin Theroux Romance is for Real
Jennifer Aniston and Justin Theroux Romance is for Real
The romance between Jennifer Aniston and Justin Theroux is for real. They have bonded over the commonest of mutually shared experiences.
 
 
Megan Fox Joins Instagram in Style
Megan Fox Joins Instagram in Style
Megan Fox joins Instagram recently in her own style.
 
 
Blake Lively&#039;s New Gucci Campaign Looks Amazing
Blake Lively's New Gucci Campaign Looks Amazing
She looks beautiful of course