HHS: $60 Billion in Medicare and Medicaid Overpayments in 2013
The U.S. Department of Health and Human Services (HHS) estimated that in 2013 it improperly spent about $65 billion in taxpayer funds through waste, errors, and fraud, a figure that was primarily fueled by an estimated $60 billion in overpayments to Medicare and Medicaid.
Fraud control benefits bottom line
Fraud, abuse and overpayment increases annual claims costs by up to 10% annually, but if addressed with a comprehensive fraud control program, could be money returned to the bottom line. “Provider and member fraud can drive up the price of healthcare and diminish the quality of care,” says David Deaton, a partner in O’Melveny & Myers LLP’s Los Angeles office and a member of the Health Care and Life Sciences Practice. “An effective fraud control program can lower premiums, increase quality for members, make healthcare coverage more accessible and protect the financial viability of a health plan.”
Medicare And Medicaid Fraud Is Costing Taxpayers Billions
When President Obama pushed through his health care bill, he cut more than $500 billion (over 10 years) in future Medicare spending in order to claim the bill was “paid for.” A better option would have been to aggressively target Medicare and Medicaid fraud, which could have provided the same amount of savings, and possibly more.
What you need to know about the two-midnight rule
In August, CMS issued the FY 2014 Inpatient Prospective Payment Systems (IPPS) final rules, including one that requires an inpatient admission to extend more than two midnights for Medicare Part A reimbursement. The rule took effect on October 1.
Payers face top industry trends head on
With healthcare reform moving ahead as planned, increased competition from new initiatives such as health insurance exchanges (HIXs) and a host of other challenges, payers have their hands full.