CMS expects $370 million in improper payment recovery
The CMS said a new effort to reduce improper payments in Medicare Advantage plans will recover about $370 million in overpayments in the first year. The CMS calculates that the rate of improper payments by Medicare Advantage organizations was about 11% in fiscal 2011, or $12.4 billion of the total $112.2 billion in the program. The CMS will identify 30 plans each year that analysts will examine in order to calculate a plan-specific error rate and overpayment. Jonathan Blum, the CMS’ deputy administrator and director for the Center for Medicare at the CMS, said the audits aim to ultimately “change the behavior of Medicare Advantage plans so they (the plans) ensure that the diagnoses codes they submit to the CMS are accurate,” which will drive down the overall error rate. The CMS will choose a new sample of 30 plans each year. “We will oversample those coding the most aggressively,” Blum said. “We’re going to target those.” Meanwhile, HHS’ inspector general’s office issued a report finding that Advantage plans lack a “common understanding” about federal anti-fraud requirements. “Differences in the way organizations defined and detected potential fraud and abuse may account for some of the variability in the number of incidents they identified,” according to the report. Three Democratic members of the House Energy and Commerce Committee requested a hearing on the findings.