The Government Accountability Office reported that in 2017 HHS made $36.2 billion in improper Medicare FFS payments and $36.7 billion in improper payments to Medicaid; MA received $14.2 billion improperly and Medicare Part D was improperly paid $1.2 billion.
The GAO estimated the federal government spent nearly $147 billion on improper payments in 2017.
The GAO recommended additional oversight from the Office of Management and Budget (OMB) to address issues with improper payments and recommended developing guidance and a risk-based methodology to assess improper payments.
Currently, Medicare FFS and Medicaid payments flagged as non-responsive from beneficiaries and providers are considered improper payments. The GAO wrote,
“Further, although OMB guidance addresses requirements for sampling, it does not address how agencies test to identify improper payments. Without such assessments and guidance, there is increased risk that agencies’ processes may not address key risks of improper payments in their programs, calling into question the improper payment estimates for such programs and their usefulness for developing effective corrective actions.”
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