The Centers for Medicare and Medicaid Services (CMS) has released a report on improper payment rates for the agency’s programs in Fiscal Year (FY) 2025, which showed the Medicare Fee-for-Service (FFS) estimated improper payment rate at 6.55 percent, or $28.83 billion, compared to the FY 2024 reported rate of 7.66 percent, or $31.70 billion.

CMS said the FY 2025 estimate marks the ninth consecutive year the rate has been below the 10 percent threshold for compliance established by
statutory requirements.

The Medicare Part C estimated improper payment rate was 6.09 percent, or $23.67 billion, compared to the FY 2024 reported rate of 5.61 percent, or $19.07 billion. 

The agency noted that the term improper does not equate to fraud, as there are many other reasons at play. For instance, CMS said most Part C improper payments were attributable to situations where a Medicare Advantage organization’s supporting documentation failed to substantiate the beneficiary diagnosis data submitted for payment.

The Medicare Part D estimated improper payment rate was 4.00 percent, or $4.23 billion, compared to the FY 2024 reported rate of 3.70 percent, or $3.58 billion.

More information on the improper payment program is at https://tinyurl.com/2ay52h4p. Read the fact sheet at https://tinyurl.com/bdf3arsu.

Comments or questions? Contact Patrick Connole at pconnole@parkplacelive.com