Healthcare IT Interoperability, EHR interoperability, Hospital Interoperability

Public Payers News

DC Tops Medicare List for Wasteful Healthcare Spending

It was found that the District of Columbia had the largest amount of waste per consumer throughout the country with nearly $178 wasted per individual.

By Vera Gruessner

- When it comes to medical care reimbursement, one of the most pivotal issues is eliminating wasteful healthcare spending. The Council for Medicare Integrity released a report detailing wasteful healthcare spending throughout the Medicare fee-for-service program.

Wasteful Medicare Spending

In particular, the analysis measures how much money was wasted per beneficiary. It was found that the District of Columbia had the largest amount of waste per consumer throughout the country with nearly $178 wasted per individual.

This type of finding is important to address, as Washington D.C. actually includes the smallest number of Medicare beneficiaries throughout all 50 states, according to records from the Centers for Medicare & Medicaid Services (CMS).

“Medicare loses more money to waste than any other Federal program. According to FY2014 Comprehensive Error Rate Testing (CERT) conducted by CMS, the Medicare FFS program has a 12.7 percent billing error rate,” the report stated.

  • Why State Medicaid Expansion May be Worthwhile for All
  • Comprehensive Primary Care Plus Program Selects Anthem BCBS
  • $18M Claimant Case Challenges Affordable Care Act Payers
  • AMA, AHA Find Health Insurance Mergers Harmful to Consumers
  • Primary Care, Coordination Drive Accountable Care Organizations
  • Patient Incentives from Payers Encourage Preventive Care Visits
  • Medicaid Service Equals or Surpasses Private Health Payers
  • How Value-Based Care Payment Models Could Reduce Costs
  • Ambulatory Surgery Centers Decrease Costs by $38 Billion
  • Key Steps for Payers to Improve Population Health Management
  • How to Design and Support an Accountable Care Organization
  • ACA Risk Adjustment, Reinsurance Improved Payer Financials
  • Aetna to Offer New HMO Option for Delaware State Employees
  • HHS Positions Bundled Payment Models Toward Cardiac Care
  • How Medical Consortium Handles Value-Based Care Reimbursement
  • Does Reference Pricing Reduce Costs of Diagnostics for Payers?
  • Kansas Lawmakers Vote for Medicaid Expansion Under the ACA
  • 5 Best Practices to Advance Value-Based Care Reimbursement
  • Top 3 Ways Accountable Care Organizations Could Garner Savings
  • AHIP: Graham-Cassidy Bill a Poor Choice for Payers, Patients
  • Health Insurance Marketplace Cuts Costs, CMS Boosts Quality
  • Socioeconomic Data Improves Public Health, Payer Programs
  • Facing an Empty Exchange, Iowa Suggests Statewide Insurance Plan
  • 10 Million Expected to Enroll via Health Insurance Marketplace
  • Sick Members More Likely to Leave Medicare Advantage Plans
  • ‘Data is Key’ to Cut Healthcare Spending, Boost Engagement
  • Cost Transparency, ‘Consumer-driven Healthcare’ Impacts Payers
  • Value-based Care, Member Incentives May be Payers’ ‘Holy Grail’
  • Payers May Be Neglecting a Growing Medicare Advantage Market
  • CMS Proposes New Rule to Stabilize Health Insurance Exchanges
  • Affordable Care Act Payment Program Boosts Care, Cuts Costs
  • WA Health Insurance Exchange In Flux With CSR Confusion
  • 64% of Polled Doctors Plagued by Rising Medical Spending
  • Why Payers Should Reduce Cost Sharing for High-Value Care
  • Medicare Part B Drug Prescribing Model Benefits Beneficiaries
  • Children’s Health Insurance Program Funding Extended to 2017
  • House Introduces Bill to Delay CMS Hospital Star Ratings
  • Health Insurance Exchange Displays 2 Consumer Engagement Tools
  • Premier Offers Healthcare Policy Improvements for ACOs, Payers
  • CMS Extends Pediatric Alternative Payment Model Comment Period
  • Three Steps to Address Healthcare Spending of New Technologies
  • 3 Key Steps for Health Payers to Meet HEDIS Quality Measures
  • Healthcare Orgs React to House Vote on American Health Care Act
  • OR May Cut ACA Medicaid Expansion Funds to Favor State Budget
  • Blue Cross Health Plans Expand Value-Based Care Reimbursement
  • Top 4 Ways Payers Could Improve Patient Health Outcomes
  • CMS Seeks Input to Implement Modular Medicaid IT Solutions
  • Humana Expands Medicare Orthopedic Bundled Payment Programs
  • Joint Replacement Bundled Payment Cut Costs, Maintained Volume
  • Aetna’s Humana Acquisition Bringing Strong Opposition
  • CMS Innovation Center’s Role in Improving Value-based Care
  • Blue Shield, Accountable Care Organization Saved $325 Million
  • AMA: Health Insurance Merger Cuts Medicare Advantage Competition
  • 1.5M Workers Gained Employer-Sponsored Healthcare Coverage
  • CMS Stresses Informed Decision-Making in Performance Reports
  • Accountable Care May Bring Savings in Healthcare Costs
  • Payer Collaboration Can Address Social Determinants of Health
  • Blue Cross to Expand Value-Based Care Reimbursement in 2017
  • CMS Accountable Care Organization Model Targets Dual Eligibles
  • Why Provider-Sponsored Health Plans are Gaining Ground
  • The History and Evolution of CHIP and the Medicare Program
  • Wellmark BCBS Latest to Exit ACA Health Insurance Exchanges
  • CMS Bundled Payment Models Address Cardiac Care, Hip Surgeries
  • Consumer-Driven Health Plans Reduce Medical Care Utilization
  • Senator Calls for Scrutiny of Health Payers, Medicare Fraud
  • Balance Billing Hits Patients with Surprise Healthcare Costs
  • Accountable Care Organizations May Improve Diabetes Management
  • Will Health Insurance Exchange Remain Intact Despite Hurdles?
  • HHS Approves Alaska 1332 Waiver for State Reinsurance Program
  • Patient Engagement Helps Payers on Affordable Care Act Exchanges
  • How State Policymakers Impact the Health Insurance Mergers
  • Cigna Partners with Scripps Health in Pay-for-Performance Model
  • How Care Management Strategies Could Reduce Medical Costs
  • Healthcare Insurance Mergers to Reduce Market Competition
  • AMA: Insurer Mergers Expand Market Power, Reduce Competition
  • Maine Medicaid Waiver Would Increase Patient Responsibility
  • Bill Would Make Health Insurance Liable for Antitrust Laws
  • Pharmaceutical Industry Slow to Embrace Value-Based Contracts
  • 3 Whistleblower Suits Net over $60 Million in Medicare Fraud
  • Key Steps toward Affordable Health Insurance Platforms
  • ‘The Future is Accountable Care,’ Population Health Management
  • Health Insurance Actuaries Propose Ways to Stabilize Market
  • Bundled Payments Benefit Payers, Increase Quality of Care
  • Do Beneficiary Incentive Programs Cut Costs, Prevent Disease?
  • Are Bundled Payment Systems Suitable at Cutting Medicare Costs?
  • Will Divestitures Preserve the Health Insurance Mergers?
  • CMS Announces Cost Reduction Medicare Advantage VBID Model
  • Health Plan Solutions: Do Employers Choose Private Exchanges?
  • Spike in Late Stage Cancer Diagnosis Related to Medicaid Cut
  • CMS Releases Final Rulings for 2016 Healthcare Payment Models
  • Is the Medicare Part B Proposed Rule ‘Bad Medicine’?
  • Accountable Care Organizations Expand Use of Social Services
  • Healthcare Spending on Brand Name Drugs Grew 8% in 2014
  • How Total Cost of Care Transparency Aids Payment Reform
  • Hospitals Lagging Behind in Population Health Management
  • AAI Asks DOJ to “Just Say No” to Health Insurance Mergers
  • WI Medicaid Waiver Adds Drug Testing, Behavior Incentives
  • State Workers’ Health Insurance Claims at Risk in Illinois
  • Nevada Legislature: All Residents Should Have Medicaid Access
  • Amerigroup Creates Risk-Based Partnerships for Medicare Advantage
  • “This error rate equates to the program losing $46 billion annually due to provider misbilling. Unfortunately, the Medicare error rate continues to trend upward, having risen 1 significantly each of the past two years.”

    The analysis also offered nine other states that were found to have some of the highest levels of wasteful healthcare spending. The list includes Arkansas, Mississippi, North Dakota, Louisiana, Oklahoma, Colorado, Texas, New Mexico, and South Dakota.

    The Council for Medicare Integrity discovered that South Dakota – in 10th place – wasted less than half of the medical spending as the District of Columbia, which took first place. Vermont was the state with the smallest amount of wasteful healthcare spending per beneficiary with only $7.58 being billed inaccurately per consumer.

    North Dakota and South Dakota rank at the top as well when it comes to wasteful healthcare spending while at the same time having some of the smallest numbers of Medicare beneficiaries throughout the nation.

    “Medicare loses more money to waste than any other government program – $46 billion in FY2014 alone – and the billing error rate continues to be on the rise. This incredible loss of taxpayer dollars is one of the top reasons Medicare Trustees now say the program will be bankrupt within the next 15 years. Medicare auditing is more necessary than ever to ensure the program will be in place when we need it in the future. It’s time to stand up and ensure your Member of Congress supports the RAC program’s work to prevent the waste of your taxpayer dollars,” Kristin Walter, spokesperson for the Council for Medicare Integrity, said in a public statement.

    The analysis from the Council for Medicare Integrity also detailed rates of returned underpayments and the states with the smallest amount of wasteful healthcare spending within the Medicare fee-for-service program.

    The states with the least Medicare wasteful spending include New Hampshire, Wisconsin, Maine, Minnesota, Idaho, Massachusetts, Maryland, Oregon, and Rhode Island. Those with the least underpayments in the Medicare fee-for-service program include Maryland, Delaware, New York, Connecticut, Iowa, Montana, Pennsylvania, New Jersey, Wyoming, and Nebraska.

    The reason this analysis is so important is due to the breakdown of one potentially vital program within the federal government. The Recovery Audit Contractor program, which used to overlook and review Medicare billing as well as recover funds that were incorrectly paid out through CMS, has been scaled back since the beginning of 2014 due to pushbacks from hospitals.

    As such, it is important for the federal government to keep an eye on the states that have high levels of wasteful healthcare spending and reign in any problems before they escalate. The Council for Medicare Integrity analysis report will be a key step forward in addressing these concerns.

    “Each state must do their part to curb Medicare misbilling,” Walter continued. “If all entities involved made eradicating waste a priority, we would not have to worry about losing Medicare altogether in 2030.”


    Sign up for our free newsletter:

    Our privacy policy

    no, thanks