New Financial Report on Improper Medicare Payment Rates Signals Need for Program Integrity Reforms

Washington — A recently released financial report from the Centers for Medicare and Medicaid Services (CMS) underscores the need for program integrity reforms in the Medicare system as evidenced by the increased amount of funds lost to improper payments in 2012 from 2011. According to the report, the amount of funds lost to improper payments grew to $29.6 billion in 2012 from $28.8 billion in 2011, which equals an improper payment rate of 8.5 percent for fiscal 2012. In 2010, the Administration set a goal of reducing the rate to 5.4 percent by 2012, half of the improper payment rate for 2009.

While the government has put greater emphasis on efforts to stop waste, fraud and abuse, evidence-based policy proposals developed by the private sector may offer effective solutions for reducing Medicare costs and strengthening the Medicare program, according to the Partnership for Quality Home Healthcare.

The Partnership for Quality Home Healthcare – a national coalition representing more than 1,500 skilled home healthcare agencies working to help ensure access to quality home healthcare services for all Americans – is a strong proponent of protecting beneficiaries and taxpayers alike by preventing fraud and abuse in the Medicare program. Together with other leaders in the healthcare community, the Partnership has developed viable policy solutions to combat fraud and abuse in the system by stopping aberrant claims and improper payments before they occur.

The home healthcare proposal – “Skilled Home Healthcare Integrity and Program Savings” (SHHIPS) – aims to prevent overpayments before they happen by enforcing stricter entry rules and payment reforms to ensure less wasteful spending and criminal activity in the system. The SHIPPS proposal also puts forth a stricter process for reviewing claims. The SHHIPS proposal is based on successful policy solutions previously put forth by the home healthcare community in 2009, including an outlier payment policy reform, which CMS estimates saved $853 million in 2010 — equivalent to $11 billion in savings over the next 10 years.

The Partnership is also part of Fight Fraud First!, a coalition on behalf of seniors, persons with disabilities, military veterans, and family members to advocate for the elimination of waste, fraud and abuse in Medicare and Medicaid. Members of the FFF! coalition are urging lawmakers to find significant savings within Medicare and Medicaid without harming the seniors and Americans with disabilities who rely on these valuable programs.

“We commend the Administration for their efforts to combat waste, fraud and abuse in the Medicare system and recognize that much has already been recovered,” stated Senator John Breaux, senior counsel to the Partnership for Quality Home Healthcare. “However, more must be done so our nation’s senior citizens do not shoulder the burden of responsibility for bad actors and weak program integrity standards. The home healthcare community stands ready to work with the Administration to strengthen the Medicare program and ensure the stability of the Medicare system for years to come.”