I linked to an article put out by CBS news that suggested $60 billion in Medicare fraud losses. I’ll be displaying some of those cases and frauds later on, but right now I want to mention data that support the CBS estimate. The data are published by a department of the U.S. government, HHS, Health and Human Services. I found this referenced in a detailed comment beneath the CBS article. The government report is here. On page 12 is a table with some information on “improper payments” made by Medicare. I quote:
“The national paid claims error rate for those claims reviewed under the strictest criteria, when applied to the entire year, is 12.4 percent or $35.4 billion (this amount was derived from statistical calculations based on the sub-sample reviewed).”
This includes two plans (fee for service and medicare choice). It excludes drug plans. This does not include Medicaid. That’s separate. That has a reported improper payment rate of 9.6 percent.
Improper payments are not necessarily frauds. The definitions of improper payments are government definitions. As such, they are all open to question. There are innumerable points that can be raised that I have no intention of raising or addressing. They will merely divert attention from the main point, which is that the government’s administration of Medicare is subject to an enormous degree of fraud, waste, and improper payments, in absolute terms or as compared with a business like Walmart that handles cash flows and customers in the same order of magnitude.
