GAO Report Examines Improper Rates

WASHINGTON, D.C. (April 5, 2019)—Last week, the Government Accountability Office (GAO) published a report titled, “Medicare And Medicaid CMS Should Assess Documentation Necessary to Identify Improper Payments.” For the report, the GAO examined the portion of the improper payment rates for Medicare and Medicaid programs that are attributed to insufficient documentation. In FY 2017, Medicare’s improper payment rate due to insufficient documentation was 6.1%, and it was greater than Medicaid’s, which was 1.3%.

However, the gap is even more significant for services like DME, where Medicare’s rate was 27 percentage points greater than Medicaid. GAO reports that this variation is due to the differences in the documentation requirements for the two programs.

AAHomecare was interviewed for the report and expressed concern with the stringent documentation requirements under Medicare. While the improper payment rate for DME is 35.5%, the majority of this is due to insufficient documentation, not medical necessity. Providers can read the GAO report here.