Washington Hospitals Overbilled Medicare $50 Million

FOR IMMEDIATE RELEASE                       
Kristin Walter
(202) 898-0995

 Washington Hospitals Overbilled Medicare $50 Million

Washington, D.C. – Washington state ranks number 24 on a list of worst states for Medicare waste, overbilling Medicare $50 million in 2013, according to the most recent annual report by the Center for Medicare and Medicaid Services (CMS). Improper Medicare billing among the state’s healthcare providers increased $11 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[i], equating to a Medicare Trust Fund loss of $46 billion in FY2014 alone[ii]. Because of this trend, healthcare officials estimate the Medicare Trust Fund will be insolvent by 2030[iii]. According to CMS, the RAC program is a valuable tool for reducing improper payments in Medicare. With an average accuracy rating of 96 percent[iv], RACs have recovered more than $8.9 billion in improper Medicare payments since the program started in 2009[v].

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[vi]. For example, two OIG Medicare Compliance Review reports released in 2014 found the University of Washington Medical Center[vii] and the Swedish Medical Center–First Hill[viii] overbilled Medicare $3.2 million in improper payments alone.

“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.

[i] FY2014 Department of Health and Human Services Agency Financial Report, Page 11: http://www.hhs.gov/afr/fy2014-agency-financial-report-final.pdf
[ii] GAO: Government Efficiency and Effectiveness, Page 26: http://www.gao.gov/assets/670/668828.pdf
[iii] 2014 Medicare Trustees Report, Page 7: http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/ReportsTrustFunds/Downloads/TR2014.pdf
[iv] FY2013 RAC Report to Congress, Page 42 (average of the 4 numbers) http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Downloads/FY-2013-Report-To-Congress.pdf
[v] Accumulation of Medicare FFS Recovery Audit Program Quarterly Reports: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Recent_Updates.html
[vi] FY2013 RAC Report to Congress, Page 36: http://www.cms.gov/Research-Statistics-Data-and-Systems/Monitoring-Programs/Medicare-FFS-Compliance-Programs/Recovery-Audit-Program/Downloads/FY-2013-Report-To-Congress.pdf
[vii] http://oig.hhs.gov/oas/reports/region9/91302049.pdf
[viii] http://oig.hhs.gov/oas/reports/region9/91302048.pdf

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