“Improper Medicaid payments exceed $57 billion for fiscal year, CMS says,” by Lois A. Bowers, McKnight’s Senior Living
“Improper Medicaid payments for fiscal year 2019 are estimated at $57.36 billion, a 14.9% rate, the Centers for Medicare & Medicaid Services said Monday. The amount is an increase from $36.2 billion in fiscal year 2018 (a 9.79% rate), but CMS said data for the two years are not comparable due to changes in the way the agency calculates the measurements. Improper payments now are calculated using the Payment Error Rate Measurement, or PERM, program, which was ‘paused’ from FY 2014 to FY 2018 as states were implementing new rules under the Affordable Care Act, CMS said. … Most errors, CMS said, are related to states maintaining insufficient eligibility documentation, not conducting timely and appropriate annual redeterminations, and claiming beneficiaries under incorrect eligibility categories that provide a higher federal matching rate.” (Emphasis added.)
LTC Comment (from Stephen A. Moses, President, Center for Long-Term Care Reform):
This backs up the WSJ column we featured yesterday: “Why Obama Stopped Auditing Medicaid.” Note the last sentence especially which confirms what we’ve been saying about Medicaid’s LTC eligibility sieve.