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2019 Estimated Improper Payment Rates for CMS Programs

Posted on Monday, November 25, 2019 1:46 PM

The Improper Payments Information Act of 2002 (IPIA) requires CMS to periodically review programs it administers, identify programs that may be vulnerable to significant improper payments, estimate the amount of improper payments, and report on the improper payment estimates and the Agency’s actions to reduce improper payments in the Department of Health & Human Services (HHS) annual Agency Financial Report (AFR).

The Office of Management and Budget (OMB) has acknowledged Medicare Fee-For-Service (FFS), Medicare Part C, and Medicare Part D; Medicaid; and the Children’s Health Insurance Program (CHIP) as at-risk for significant improper payments. CMS implemented improper payment measurement programs for these programs and continues to address the drivers of improper payment rates through aggressive corrective action plans.

Improper payment rates are not indicative of fraud; however, improper payments are payments that did not meet statutory, regulatory, administrative, or other legally applicable requirements and may be overpayments or underpayments. 

FY 2019 Estimated Improper Payment Rates and Improper Payments (Billions)

Program

2018 Improper Payment Rate

2018 Improper Payments

2019 Improper Payment Rate

2019 Improper Payments

Medicare FFS

8.12%

$31.62

7.25%

$28.91

Medicare Part C

8.10%

$15.55

7.87%

$16.73

Medicare Part D

1.66%

$1.32

0.75%

$0.61

Medicaid

9.79%

$36.25

14.90%*

$57.36*

CHIP

8.57%

$1.39

15.83%*

$2.74*

*Medicaid and CHIP 2019 estimated improper payments are not comparable to previous years due to the reintegration of the PERM eligibility component.

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