Medicare remains a “high-risk” federal program due to the Center for Medicare and Medicaid Services’ failure to lower Medicare’s rate of improper payments, which totaled over $44 billion in 2012, according to the Government Accountability Office.
“CMS has not met GAO’s criteria to have the Medicare program removed from the High-Risk List. For example, although CMS has made progress in measuring and reducing improper payment rates in different parts of the program, it has yet to demonstrate sustained progress in lowering the rates,” according to GAO’s written testimony before the House Subcommittee on Health, Committee on Energy and Commerce on Wednesday.
“Because the size of Medicare relative to other programs leads to aggregate improper payments that are extremely large, continuing to reduce improper payments in this program should remain a priority for CMS.”
In 2012, the Medicare program “covered more than 49 million elderly and disabled beneficiaries at an estimated cost of $555 billion, and reported improper payments estimated to be more than $44 billion,” according to GAO.
In 1990, GAO “designated Medicare as a high-risk area” due to its “complexity and susceptibility to improper payments, which, added to its size, have led to serious management challenges.”
According to the federal government, “improper payments” occur when “funds go to the wrong recipient, the right recipient receives the incorrect amount of funds (including overpayments and underpayments), documentation is not available to support a payment, the recipient uses funds in an improper manner.”
“Medicare spending must be held much more firmly in check to sustain the program over the long term, while continuing to ensure that beneficiaries have access to appropriate health care,” said GAO.