Bass, Berry & Sims attorney Danielle Sloane offered insight for an article detailing how Medicaid and the Children’s Health Insurance Program (CHIP) failed to limit improper health payments, costing the programs $36.25 billion and $1.39 billion respectively in FY 2018. According to a recent federal audit, Medicaid had an improper payment target rate of 7.93% for FY 2018, but it was actually 9.79%; the CHIP program had a target rate of 8.2%, but only achieved 8.57% for the same time period.

“To meet the rate, CMS likely has to devote more resources, which likely isn’t worth the cost of Medicaid losing participating providers as a result of added administrative burdens,” Danielle told Bloomberg Law.

The audit also criticized CMS for failing to establish a recovery audit contractor (RAC) program that would be responsible for discovering and recovering improper funds paid through Medicare Advantage. “CMS is likely hesitant to establish a [RAC] program that will lead to a further backlog of Medicare appeals, a process that has drained both Medicare and provider resources alike,” Danielle said.

The full article, “Government Fails to Squelch Bad Health Payments for Poor, Kids,” was published by Bloomberg Law on May 16, 2019, and is available online (subscription required).