CMS Report: Providers Falsely Billed Medicare by $49.9 Billion in 2013


December 19, 2013                                                                

CONTACT: Kristin Walter
(202) 898-0995

CMS Report: Providers Falsely Billed Medicare by $49.9 Billion in 2013
Report shows uptick in improper payments, calls for increased program oversight and auditing

Washington, D.C. – The American Coalition for Healthcare Claims Integrity (ACHCI) today released the following statement in response to the Department of Health and Human Services FY2013 Agency Financial Report, released this week. According to the report, improper payments by Medicare amounted to more than $49.9 billion in 2013, up from $44.3 billion in 2012.

“This report highlights the critical importance of Medicare integrity initiatives like the Recovery Audit Contractor (RAC) program. Recovery Auditors review claims data to identify misused Medicare funds, and consistently return more than $1 billion to the healthcare system every quarter. As providers continue to overbill Medicare, strengthening the RAC program must remain a top priority. Our coalition will continue to combat this alarming trend in improper payments and is fiercely committed to eliminating waste in Medicare,” said coalition spokesperson Kristin Walter.

“The mission of our coalition is to promote integrity in our healthcare system. As the legislative session draws to a close, we strongly encourage members of Congress to oppose any effort to weaken or dismantle Medicare waste-prevention programs, such as The Two-Midnight Rule Delay Act of 2013 (H.R. 3698). We will continue to work with CMS, lawmakers and providers to weed out waste in Medicare and better serve the 50 million beneficiaries that rely on the program every day.”

Senator Tom Carper (D-Del) echoed the coalition’s sentiments in a statement released by his office earlier this week.

“Today’s disclosure by the Centers for Medicare and Medicaid Services (CMS) is an important reminder that these programs remain at risk of improper payments,” said Carper, in the release. “[…] I am concerned that there has been an increase in improper payments made in Medicare. I often like to say that the road to improvement is always under construction, and the same is true for improving accuracy in Medicare and Medicaid payments.”

For more information, please visit: www.properpayments.com

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About the American Coalition for Healthcare Claims Integrity

Founded in 2009, the American Coalition for Healthcare Claims Integrity (ACHCI) is a non-profit organization committed to working toward achieving 100% accuracy in payment claims submitted to public and private sector healthcare payors. The coalition’s mission is to educate policymakers and other stakeholders regarding the importance of healthcare integrity programs that help identify and correct improper payments.  ACHCI’s founding members are partners in critical accountability initiatives including the federal Recovery Audit Contractor (RAC), Zone Program Integrity Contractor (ZPIC), and Medicaid Integrity Contractor (MIC) programs.

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