CMS Administrator Seema Verma

Home health changes resulted in a $5.9 billion decrease in estimated improper payments from fiscal year 2016 to fiscal year 2020, the Centers for Medicare & Medicaid Services announced.

The changes, according to the agency, included the clarification of documentation requirements and the education of providers through the Targeted Probe and Educate program.

The Medicare fee-for-service improper payment rate has continued to decline over the past four years, resulting in an estimated $15 billion reduction in improper payments, largely to home health and nursing home providers, the agency also said.

The FY 2020 Medicare FFS estimated improper payment rate is 6.27%, representing $25.74 billion in improper payments, CMS said. This compares with the FY 2019 estimated improper payment rate of 7.25%, representing $28.91 billion in improper payments, according to the agency. The decrease was driven by reductions in the improper payment rates for home health and skilled nursing facility claims, CMS said.

“To protect Medicare for our seniors, we must ensure that fraud and abuse doesn’t rob the program of precious resources,” CMS Administrator Seema Verma said. “From the beginning this administration has doubled down on our commitment to protect taxpayer dollars and this year’s continued reduction in Medicare improper payments is a direct result of those actions.”