Mississippi Business Journal: Report: State third worst in Medicare waste

Report: State third worst in Medicare waste

Mississippi was the third worst state in Medicare waste per beneficiary in fiscal 2014, according to the Council for Medicare Integrity.

Overpayments in Medicare parts A and B for Mississippi totaled $55,048,689.18, ranking behind only the District of Columbia, which was the worst, and Arkansas.

Nationwide, hospitals accounted for $29.6 billion of a total of $46 billion in overpayments for fiscal 2014, according to the council. The others were billing for durable medical equipment, $5.1 billion, and physicians, labs and ambulance services, $11 billion.

The council lobbies for nonprofit auditors hired by the federal Centers for Medicare and Medicaid Services.

Overpayments to Mississippi’s 472,274 beneficiaries averaged $116.56, according to the report.

It’s yet another grim report on the government health insurance program for those over 65. The program marked its 50th anniversary this year. It and Medicaid, which is for the poor, were part of President Lyndon Johnson’s Great Society effort.

“Medicare Trustees recently reported that due to rising enrollment in the program and current spending levels, Medicare is slated to be bankrupt in . . . 2030,” the report said.

“But the news doesn’t have to be so grim,” the report continues. “Medicare is losing billions of taxpayer dollars that can simply be recouped or corrected to extend the life of the program.”

However, the trend in the past few years is not encouraging, according to the council.

The error rate in fiscal 2012 was 8.5 percent and in fiscal 2013 it was 10.7 percent.

In fiscal 2014 it was 12.7 percent.

The council is lobbyist for recovery audit contractors, or RACs, authorized by Congress. The council says more than $10 billion has been recovered since 2010.

However, “due to pressure from the hospital industry, which the RAC program has been scaled back significantly, with auditors only able to review less than half of the problematic billing issue areas that had previously been approved to audit,” the council said in a release.

“Each state must do their part to curb Medicare misbilling,” the council said. “If all entities involved made eradicating waste a priority, we would not have to worry about losing Medicare altogether in 2030.”

Richard Roberson, general counsel and vice president for state advocacy of the Mississippi Hospital Association, said the state’s poor showing in the report is influenced by the fact that its claims are typically more complex than those from much of the rest of the nation.

That’s because so many claimants have more than one chronic condition he said.

Plus, the state’s providers – which include more than hospitals – win 50 percent of its appeals of findings of overbilling, he said.

Appeals became so prevalent that the audit recovery effort was put on hold for a while in 2014, he said.

Mistakes tend to be administrative in nature rather than for wrong diagnoses and treatment, Roberson said.

Also, audit contractors are incentivized to find overpayments rather than underpayments, Roberson said, noting that the report ranks Mississippi fourth-worst in Medicare underpayments, $6.45 per beneficiary.

As for the dire predictions of eventual bankruptcy of the Medicare system, Roberson said that from the beginning of the government health insurance program for those 65 or older there have been warnings.

The American Hospital Association does its own auditing of the recovery auditor contractors, or RACs.

It initiated a quarterly RACTrack report in January. The unofficial, private report found that in the third quarter of 2015 that 60 percent of what RACs had reported as overpayments were in fact not.

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