“On November 19, 2019, CMS announced key results from the 2019 HHS Agency Financial Report, which generally provides fiscal and high-level performance data for HHS for the reporting period of October 1, 2018 through September 30, 2019. While CMS leads off its press release with the good news — payment error rates in the Medicare fee-for-service program are at their lowest level since FY 2010 — it concludes with a startling statistic: the national Medicaid improper payment estimate for FY 2019 is 14.9%, or $57.36 billion. As a result of this number, CMS commits in its press release to focus specifically on eligibility audits going forward (in general, making sure that (1) individuals who are enrolled in Medicaid should in fact be enrolled; and (2) for those that are properly enrolled, ensuring they are properly classified). This echoes recent statements by Administrator Seema Verma at NAMD, where the Administrator noted…”
“Understanding PERM
As part of HHS’ efforts to combat fraud, waste, and abuse, the agency operates the Payment Error Rate Measurement, or PERM program. As part of PERM audits, HHS estimates Medicare and Medicaid improper payments on a rolling, annual basis utilizing federal contractors to measure three components: fee-for-service (FFS), managed care, and eligibility…” Read the full post here.
Source: Latest HHS Financial Report Highlights Medicaid Eligibility Errors – and Foreshadows Future Actions – By Ross Margulies, November 25, 2019. JD Supra.
