Will we take action about Medicare improper payments?

Why are we, as a nation, so complacent about our government’s wasteful spending? Thousand-dollar toilet seats, expensive presidential haircuts on Air Force One, extensive misbilling. We’re all supposedly shocked when we hear of these things, but we shake our heads and move on. Nothing changes and incredible levels of waste persist year after year, decade after decade.

Most Americans don’t know that Medicare wastes more money than any other government program – in fact losing $125 billion in taxpayer dollars due to improper billing during the past three years alone.  This isn’t fraud we’re talking about. This massive amount of waste is caused by simple billing mistakes taking place on a grand scale, services billed to the wrong code (often for higher reimbursement), services billed without proper documentation and the same service for a patient billed two or even three times. Medicare providers bill the program and receive reimbursement for their services – whether their bill is accurate or not.

The interesting thing is that this money is absolutely recoverable. Congress launched a program in 2009 to identify and return these misbilled dollars back to the Medicare program. The Recovery Audit Contractor (RAC) program has returned more than $10 billion back to the Medicare Trust Funds while reviewing only 2 percent of provider’s medical records.

Unfortunately, despite the government having successful tools at their disposal to recover billions in improperly spent taxpayer dollars, Medicare integrity programs have been scaled back to a trickle while our tax dollars pad the bottom lines of providers who have misbilled Medicare.

Despite saddling us with an egregious 12 percent error rate, providers have complained about the “burden” of being audited. As a result, the RAC program has been whittled away to nearly nothing, now only permitted to review half of one percent (0.5%) of a provider’s medical records. This is especially shocking when you realize that private health insurers require the same providers be subject to as much as 100-percent claim review for billing accuracy, but somehow reimbursement requirements from private insurers aren’t a “burden” to providers.

In addition, inpatient hospital short stay cases, one of the areas with the very highest levels of improper billing, were given a full two-year hiatus from auditing. Meaning that for 2 years, the claim type with the highest propensity for billing errors was given a “free pass” from auditing and now, those funds cannot be recovered – we’re talking about a write off of approximately $8 billion.

Despite a lot of sharp talk at numerous Congressional hearings about how vitally important it is to stop Medicare improper payments and reading report after report from the Office of the Inspector General (OIG) detailing egregious billing errors nationwide, there’s certainly not much rubber hitting the road to make the recovery of Medicare misbillings a priority.

To add insult to injury, the Medicare Trustees just announced that at current spending levels, the program will be bankrupt by the year 2028 – just 12 years from now. This will leave shortsighted Medicare providers with less income and more importantly, will leave beneficiaries with significant reductions in health coverage and much needed services.

Just about every day we hear politicians and other officials talk about our nation’s budget crisis. More money is needed for NIH cancer research, to combat the zika virus, to support our military and to repay our nation’s debt. Now we also have to worry about a looming Medicare bankruptcy. But are we worried? There seems to be a very disturbing comfort level with flushing away $43 billion per year to improper Medicare payments.

We must get back to auditing much higher levels of Medicare claims to recover misspent funds and conserve taxpayer dollars. We must demand that providers bill Medicare accurately. And, we must insist that representatives elected to protect our best interests make the decisions necessary to stop our tax dollars from lining the pockets of a $988 billion industry – instead of funding vital healthcare coverage for our nation’s seniors.

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