‘Rampant’ Medicare Overbilling Highlights Need for Cost-Efficient Care

Medicare was overbilled by 12.1% in 2015, thanks to improper fee-for-service reimbursements in 21 states, according to the Centers for Medicare & Medicaid Services (CMS). That’s up from 8.6% just five years ago, making it one of the highest error rates in history. Louisiana was the worst offender, with an overbilling average of 19.4%—equating to over $1.2 billion in excess fees. Texas and Georgia also showed over a billion dollars in overcharges to Medicare last year. Kristin Walter of the Council for Medicare Integrity called the overbilling “rampant all across the country.” The Congressional Budget Office and the Medicare Trustees predict that at the current rate of financial decline, Medicare will be defunct by 2030. One problem is that just 0.5% of hospital bills are reviewed or verified for accuracy. While dire, such data bolster urgent care’s value as a cost-saving option compared with visits to emergency rooms for nonemergent complaints.