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St. Louis Business Journal: Kansas and Missouri slash Medicare waste, but still overbill by millions

Kansas and Missouri slash Medicare waste, but still overbill by millions

Jan 26, 2017, 1:35pm CST

The good news is that improper Medicare payments to health care providers fell sharply in 2015. The bad news: overpayments in Kansas and Missouri still accounted for millions of lost dollars.

In Missouri alone, overpayments totaled in excess of $10.2 million in 2015, the latest reporting year from the Centers for Medicare and Medicaid Services. That amount was down 69 percent from the previous year, but the state still overbilled an average of $12.71 per beneficiary.

In Kansas, overpayments were lower, at $2.36 million, or $5.67 per beneficiary. That total dropped dramatically — 91 percent — from 2014.

Nationwide, overspending totaled $350.6 million in 2015, the latest reporting year available. That figure was down approximately 85 percent from 2014’s total of $2.3 billion — an all-time high according to the Council for Medicare Integrity, a nonprofit health care research and policy concern based in Washington, D.C.

The overpayments are based on data reported through the federal government’s Recovery Audit Contractor program established last decade to identify improper billings — and to potentially recover funds — allocated through the Medicare part A and B programs.

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On a per-patient basis, Washington, D.C., topped the rankings with an average overpayment of $30.90 per eligible Medicare beneficiary. With a Medicare population of roughly 79,000 people, the nation’s capital had the fewest beneficiaries among the states analyzed. It was the second year in a row that D.C. topped the Council for Medicare Integrity’s rankings as the state with the highest overpayments per beneficiary.

Delaware, Texas, New Jersey and Oklahoma rounded out the top five states by overpayments per beneficiary. However, the gap between D.C. and Delaware — $30.90 to $22.55 — was about as large as the gap between Delaware and New Mexico, which ranked 11th by this measure.

California, the state with the most Medicare beneficiaries as of 2015, averaged overpayments of $14.72 per beneficiary, ranking it 9th-most, nationally. California also held the distinction as the state that saw the steepest year-over-year decline, to $47.8 million in 2015 from $261 million in 2014, in overpayments estimated by the federal government.

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At the other end, three states actually averaged underpayments: North Dakota averaged an underpayment of $16.95 per beneficiary, Utah averaged a $12.54 underpayment and Wisconsin averaged a $0.50 underpayment.

Nationally, the dramatic year-over-year decline in Medicare overpayments appears to stem from greater enforcement of Recovery Audit Contractor programs, which were weakened in 2013 after intense lobbying by the health care sector.

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