Reimbursement

Improper Fee-For-Service Payments Total $13.5 Billion

Medicare fee-for-service payment errors totaled $13.5 billion in fiscal 1999, or about 8% of total payments, said an audit released by the Department of Health and Human Services. The amount is up from 1998's $12.5 billion but still down from $23.2 billion in improper fee-for-service payments made in 1996. Unsupported and medically unnecessary services accounted for about $10 billion of the amount, according to the report. Senators Arlen Specter (R-PA) and Tom Harkin (D- IA) at a Senate subcommittee hearing called the improper payments unacceptable. Specter called for increasing criminal prosecutions of fraud and angrily criticized an American Medical Association statement that characterized the audit's release as "irresponsible grandstanding." Specter said, "If this is grandstanding, we need more of it." The Health Care Financing Administration will set up a telephone hotline by this summer to answer providers' compliance questions, Administrator Nancy- Ann Min DeParle said. The audit is available at http://www.hhs.gov/oig/other.

Source: AHA News Now, March 9, 2000