CMS: Medicare Advantage received $16.6B in improper payments in 2023

CMS paid Medicare Advantage organizations an estimated $16.6 billion in overpayments in fiscal year 2023, the agency reported Nov. 15. 

The estimated payment error rate in MA, or Medicare Part C, was 6.01% in fiscal year 2023, according to a CMS fact sheet. The error rate was lower than in fee-for-service Medicare, where the payment error rate was 7.38%, or $31.2 billion. 

Estimated payment error rates in 2023 were not statistically significantly different from 2022's rates, CMS said. 2023 marks the seventh year fee-for-service Medicare payment error rates were below the 10% threshold required by law. 

In its fact sheet, CMS said not all improper payments constitute fraud or abuse. Improper payments are defined as any payment that does not meet CMS' program requirements. 

"They can be overpayments or underpayments, or payments where insufficient information was provided to determine whether a payment was proper. Most improper payments involve a situation when a state, contractor, or provider misses an administrative step," the agency said in its fact sheet. 

See CMS' full report here.

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