Texas Hospitals Overbilled Medicare $152 Million, State Ranks 6th in U.S. for Medicare Waste

March 2, 2015

CONTACT: Kristin Walter
(202) 898-0995

Texas Hospitals Overbilled Medicare $152 Million,
State Ranks 6th in U.S. for Medicare Waste

Washington, D.C. – Texas ranks sixth on a national list of the worst states for Medicare waste, overbilling Medicare $152 million in 2013, according to an annual report by the Center for Medicare and Medicaid Services (CMS). Texas held its position at number six in 2013, the most recent year for which government data is available, but improper Medicare billing among the state’s healthcare providers increased $56 million over the previous year.

“With waste on the rise, it is vital to have policies in place that help preserve Medicare’s solvency,” said Kristin Walter, spokesperson for the Council for Medicare Integrity, which advocates in support of CMS’ Recovery Audit Contractor (RAC) Program. “I would urge anyone with an interest in the responsible stewardship of taxpayer dollars to contact their local members of Congress and ask them to support the Recovery Audit Program.”

Since 2011, the rate of Medicare improper payments has risen steadily from 8.6 percent to 12.7 percent, equating to a Medicare Trust Fund loss of $46 billion in FY2014 alone. Because of this trend, healthcare officials estimate the Medicare Trust Fund will be insolvent by 2030. According to CMS, the RAC program is a valuable tool for reducing improper payments in Medicare. With an average accuracy rating of 96 percent, RACs have recovered more than $8.9 billion in improper Medicare payments since the program started in 2009.

Despite the program’s success, recovery auditing has come under attack by provider groups pushing for less oversight of Medicare payments. Many of these providers, however, account for a majority of Medicare waste. According to CMS, inpatient hospitals account for 94 percent of overbillings to Medicare. In fact, OIG Medicare Compliance Review reports released in 2013 and 2014 identify four Texas hospitals that overbilled Medicare by a total of $3.5 million.

Hospital Overbillings Error Rate Date Released
St. Joseph Regional $638,960 55% August 2013
Christus Hospital – St. Elizabeths $1,319,746 84% February 2014
Christus Santa Rosa $1,192,275 70% February 2014
Baylor All Saints Medical Center at Fort Worth $371,952 50% January 2014
TOTAL/AVERAGE $3,522,933 65%

 “Unfortunately, the problem of improper Medicare payments is not limited to any one state or hospital,” said Walter. “It is an epidemic of waste that demands a commitment to preserve and strengthen the RAC program.”

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.

As a 501(c)(6) organization, the Council files IRS Form 990s annually with the IRS as required by law. Copies of these filings and exemption application materials can be obtained by mailing your request to the Secretary at: Council for Medicare Integrity, Attention: Secretary, 9275 W. Russell Road, Suite 100, Las Vegas, Nevada 89148. In your request, please provide your name, address, contact telephone number and a list of documents requested.  Hard copies are subject to a fee of $1.00 for the first page and $.20 per each subsequent page, plus postage, and must be made by check or money order, payable to the Council for Medicare Integrity. Copies will be provided within 30 days from receipt of payment. These documents are also available for public inspection without charge at the Council’s principal office during regular business hours. Please schedule an appointment by contacting the Secretary at the address above.

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