$36,731,130,000: Improper Medicaid Payments Skyrocket

By Terence P. Jeffrey | April 12, 2018 | 6:07 PM EDT

President Barack Obama and Vice President Joe Biden on the day in 2010 when President Obama signed the Affordable Care Act. (Screen Capture)

(CNSNews.com) - Improper payments made by the Medicaid program climbed from approximately $29,149,680,000 in fiscal 2015 to $36,731,130,000 in fiscal 2017, according to data published by the Department of Health and Human Services.

That is an increase of $7,581,450,000--or 26 percent.

“Despite efforts to reduce improper payments in the Medicaid program by the Centers for Medicare & Medicaid Services, which oversees the program, overall improper payments continue to increase—rising to about $37 billion in fiscal year 2017 compared to $29.1 billion in fiscal year 2015,” GAO Health Care Director Carolyn Yocom told the House Oversight and Government Reform Committee today.

“The size and complexity of Medicaid make the program particularly vulnerable to improper payments—including payments made for people not eligible for Medicaid or made for services not actually provided,” Yocom said in her written testimony.

“Due to concerns about the adequacy of oversight, Medicaid has been on our list of high risk programs since 2003,” she testified.

An improper payment, according to the GAO, “is any payment that should not have been made or that was made in an incorrect amount (including overpayments and underpayments) under statutory, contractual, administrative, or other legally applicable requirements.”

“It includes any payment to an ineligible recipient, any payment for an ineligible service, any duplicative payment, payment for services not received (except where authorized by law), and any payment that does not account for credit for applicable discounts,” says GAO.

In its annual financial reports for fiscal 2015 and fiscal 2017, the Department of Health and Human Services, reported that total Medicaid improper payments were $29,149,680,000 in fiscal 2015 and $36,731,130,000 in fiscal 2017. The $7,581,450,000 increase over two years was a jump of 26 percent.

The HHS financial reports included charts showing the annual totals for improper payments broken down by “overpayments” and “underpayments.”

In fiscal 2015, according to HHS, there were $28,627,510,000 in improper Medicaid payments that were overpayments and $522,170,000 that were underpayments. That equaled a total of $29,149,680,000 improper payments—of which 98.2 percent were overpayments.

In fiscal 2017, there were $36,447,950,000 improper Medicaid payments that were overpayments and $283,180,000 that were underpayments. That equaled a total of $36,731,130,000 in improper payments—of which 99.2 percent were overpayments.

This table from the HHS Financial Report for FY 2017 shows the $36,731,130,000 in improper Medicaid payments broken down by "overpayments" and "underpayments":

 


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