Improper Fiscal Year 2000 Medicare Fee-for-Service Payments
The objective of this review by the Dept. of Health and Human Services (HHS) Office of Inspector General was to estimate the extent of FY 2000 fee-for-service Medicare payments that did not comply with Medicare laws and regulations. Based on HHS¿s statistical sample, HHS estimates that improper Medicare benefit payments made during FY 2000 totaled $11.9 billion, or about 6.8% of the $173.6 billion in processed fee-for-service payments reported by the Health Care Financing Admin. (HCFA). As in past years, these improper payments could range from inadvertent mistakes to outright fraud and abuse. HHS recommendations address the need for HCFA to sustain its efforts in reducing improper payments. Tables and graphs.
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12 contractor quarters 1Does not add American Hospital Association American Medical Association AUDIT carrier Cl Physician claim was denied coding errors comply with Medicare Contractor medical reviews corrective action plans CPT code decision-making of high decision-making of moderate diagnosis diagnosis code downcoded durable medical equipment Error Fiscal error rate estimate of improper evaluation and management fee-for-service payments reported fraud and abuse FY 1999 estimate HCFA HCFA's health care providers high complexity home health agencies hospital was paid hypnotherapy improper payments inpatient PPS claims largest error category medical decision-making medical necessity medical records supported medical review staff medical reviewer determined medically necessary medically unnecessary services Medicare contractors MEDICARE FEE-FOR-SERVICE PAYMENTS Medicare laws Medicare reimbursement rules moderate complexity noncovered services Number of Percent outpatient percent for FY physician should typically physician was paid point estimate Services in Error Services Questioned 1996 skilled nursing facilities statistical sample sufficient documentation therapy unsupported services