Advocacy Group Urges HHS Secretary to Prioritize Reduction of Medicare Improper Payments

Washington, D.C. – Today, The Council for Medicare Integrity (CMI) sent a letter to Department of Health & Human Services (HHS) Secretary Tom Price asking for expanded efforts to reduce improper payments within the Medicare program. Last week, the Secretary testified before the Senate Finance Committee stating, “we are absolutely committed to program integrity.”

The letter urges the Secretary to bolster program integrity efforts that protect Medicare resources and discusses concerns for the financial future of the Medicare program. “With Medicare Part A set to reduce hospital coverage for beneficiaries in 2028 to 87 percent of what’s covered today, it’s more important than ever that we recover the more than $40 billion lost each year to improper Medicare billing and prevent future cuts to senior’s healthcare coverage,” said Kristin Walter, spokesperson for the Council.

Currently, the Medicare Fee for Service (FFS) program permits only 0.5 percent of claims to be reviewed for accuracy after they are paid – allowing billions of taxpayer dollars to be paid out improperly each year. In comparison, private insurers require up to 100 percent of claims to be reviewed for billing accuracy both before and after they are paid.

CMI also asks HHS to expedite additional efficiencies within the Medicare audit scenario review process to get the program back on track reviewing issues previously approved by the Centers for Medicare & Medicaid Services (CMS). The agency previously approved more than 400 error prone Medicare audit scenarios for review. Currently, fewer than 20 scenarios are permitted to be reviewed.

CMI made several recommendations to the Secretary that would help protect the future solvency of this vital healthcare program, including taking steps to leverage two proven best practices used by private insurance companies to better protect Medicare’s bottom line:

  • Reviewing higher levels of post-payment claims for billing accuracy and
  • Adding a new layer of protection by authorizing prepayment claim reviews to prevent Medicare dollars from ever leaving the program in error.

CMI asks that the Secretary follow the guidance provided for the past two years by the Government Accountability Office (GAO), which has recommended that HHS ask Congress to authorize a permanent Recovery Audit Contractor (RAC) prepayment review program to “better protect agency resources.”

“The combination of higher post-payment reviews with a new prepayment review program will go far to help close the loophole that’s permitted more than $40 billion to be lost each year to preventable Medicare billing errors. Those recovered dollars will bolster the Medicare Trust Fund and reduce the need for future Medicare coverage cuts,” said Walter.

For more information, please visit: www.medicareintegrity.org.

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About the Council for Medicare Integrity. The Council for Medicare Integrity is a 501(c)(6) non-profit organization. The Council’s mission is to educate policymakers and other stakeholders regarding the importance of healthcare integrity programs that help Medicare identify and correct improper payments.


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