A top congressional auditor dropped a bomb on Wednesday when he testified that federal health officials made more than $16 billion in improper payments to private Medicare Advantage health plans last year and the need to crack down on billing errors by the insurer.
Public Integrity reported that while testifying before the House Ways and Means oversight subcommittee, James Cosgrove, who directs health care reviews for the Government Accountability Office, said that the Medicare Advantage improper payment rate was 10 percent in 2016, which comes to $16.2 billion.
When adding in the overpayments for standard Medicare programs, the tally comes close to $60 billion. Cosgrove explained that “fundamental changes are necessary” to improve how the federal Centers for Medicare and Medicaid Services ferrets out billing mistakes and recoups overpayments from health insurers.
This comes one week after Attorney General Jeff Sessions announced the arrests of 412 people, some 100 doctors among them, in a scattershot of health care fraud schemes that allegedly ripped off the government for about $1.3 billion, mostly from Medicare.
“When trying to understand how much fraud is in Medicare, the answer is we simply don’t know,” Florida Republican Rep. Vern Buchanan, chairman of the House Committee on Ways and Means, said during Wednesday’s hearing.
“Understanding payment errors is important as every dollar reported lost in error serves to undermine the good work of the program and could represent a dollar that should be spent on providing care to beneficiaries,” Buchanan said. “However, different types of errors require different analytics and different solutions.”
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