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Medicare and Medicaid: CMS Should Assess Documentation Necessary to Identify Improper Payments

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Report Type Reports and Testimonies
Report Date March 27, 2019
Release Date March 27, 2019
Report No. GAO-19-277
Summary:

Medicare and Medicaid review medical record documentation to ensure that they're only paying eligible doctors and hospitals for medically necessary, covered services. These reviews found an estimated $27.5 billion in payment errors due to insufficient documentation in FY 2017.

We found that Medicare and Medicaid have different documentation requirements for some of the same services, contributing to substantially different estimated error rates.

We recommended that the programs look into their documentation requirements, and more.

Both programs are on our High Risk List.

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Stethoscope on a computer keyboard

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