Report: Medicare Overbilling Costs Nearly $40 Billion, Annually
A new report alleges that improper payments are costing the Centers for Medicare & Medicaid Services (CMS) billions of dollars, annually. Some observers are concerned that Medicare could become bankrupt unless immediate action is taken to correct these rising rates. Medicare overbilling data shows overpayment statistics averaged 8.6 percent in 2011, but that figure rose to 12.1 percent in 2015—which equates to a loss of $40 billion annually. Louisiana has the highest overbilling rate of 19.4 percent, followed by Texas at 17.3 percent. Alabama’s rate was 14.3 percent, last year.
All of this means that providers can expect aggressive post payment audit activity, along with associated recoupments from Program Integrity Contractors who commonly base medical necessity denials on documentation defects.