United States Government Publishing Office publisher pbl distributor dst United States Government Accountability Office author aut Government Organization text government publication eng GAOREPORTS Legislative Agency Publications gao legislative 2010-08-12 U.S. Government Printing Office 2006-03-24 monographic deposited born digital 47 p. GA 1.13:GAO-06-300 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-06-300 P0b002ee180388932 f:d06300 DGPO 2010-08-12 2011-03-23 GAOREPORTS-GAO-06-300 machine generated eng fdlp REPORT GAOREPORTS-GAO-06-300 GAO-06-300 Claims processing Claims settlement Erroneous payments Errors Medicare Statistical data Statistical methods Cost estimates Fee-for-Service Plans Comprehensive Error Rate Testing Program Hospital Payment Monitoring Program Other Written Product A49880 The Centers for Medicare & Medicaid Services (CMS) estimated that the Medicare program paid approximately $20 billion (net) in error for fee-for-service (FFS) claims in fiscal year 2004. CMS established two programs--the Comprehensive Error Rate Testing (CERT) Program and the Hospital Payment Monitoring Program (HPMP)--to measure the accuracy of claims paid. The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 directed GAO to study the adequacy of the methodology that CMS used to estimate the Medicare FFS claims paid in error. GAO reviewed the extent to which CMS's methodology for estimating the fiscal year 2004 error rates was adequate by contractor type for (1) the CERT Program, (2) the HPMP, and (3) the combined national error rate (including both the CERT Program and the HPMP). GAO reviewed relevant CMS documents and reports related to the CERT Program and the HPMP. In addition, GAO reviewed work performed by the Department of Health and Human Services (HHS) Office of Inspector General (OIG) and its contractor that evaluated CMS's fiscal year 2004 statistical methods and other aspects of the error rate estimation process. GAO also conducted interviews with officials from CMS, HHS's OIG, and their contractors. https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-06-300/html/GAOREPORTS-GAO-06-300.htm https://www.govinfo.gov/content/pkg/GAOREPORTS-GAO-06-300/pdf/GAOREPORTS-GAO-06-300.pdf GAO-06-300 https://www.govinfo.gov/app/details/GAOREPORTS-GAO-06-300 Other Written Product GAO-06-300; Medicare Payment: CMS Methodology Adequate to Estimate National Error Rate; Claims processing Claims settlement Erroneous payments Errors Medicare Statistical data Statistical methods Cost estimates Fee-for-Service Plans Comprehensive Error Rate Testing Program Hospital Payment Monitoring Program Volume 107 Page 285 107 Stat. 285 Volume 116 Page 2350 116 Stat. 2350 Volume 117 Page 2066 117 Stat. 2066 Public Law 103-62