FY 2012 RECOVERY AUDITORS DATA FROM CMS: A 49:1 RATIO OVERPAYMENTS/UNDERPAYMENTS

The Centers for Medicare & Medicaid Services released its report “Recovery Auditing in Medicare and Medicaid for Fiscal Year 2012: FY 2012 Report to Congress as Required by Section 1893(h) of the Social Security Act and Section 6411(c) of the Affordable Care Act.”

There were $2.3 billion claw-backs from health care providers.   Audits also identified $109.4 million in underpayments, and these were paid back to the health care providers.

In other words, out of 100% improper payments, the auditors found that 98% were overpayments, and 2% were underpayments – this is a 49:1 ratio.  For every $49 dollars clawed back, $1 dollar is returned.

49:1

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