Report: Medicare Overbilling Costs Nearly $40 Billion, Annually

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  • April 6, 2016
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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.

Michael Miscoe
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Mr. Miscoe, JD, CPC, CASCC, CUC, CCPC, CPCO, CPMA has over 20 years of experience in healthcare coding and over sixteen years as a compliance expert, forensic coding expert and consultant. He has provided expert analysis and testimony on a wide range of coding and compliance issues in civil and criminal cases and his law practice concentrates exclusively on representation of healthcare providers in post-payment audits as well as with responding to HIPAA OCR issues. He has an extensive national speaking background and has been published in numerous national publications on a variety of coding, compliance and health law topics.

No Responses to “Report: Medicare Overbilling Costs Nearly $40 Billion, Annually”

  1. Brian Goldsberry says:

    Do you have a link to this report with the overpayment % for each state?
    I’m in South Carolina. Thanks.